Welcome and introductions

2

Peter Williams

Rob Hausam

Recording, notes & attendance.

Check questions in Zulip and SNOMED International #snomed-hl7-fhir

Next Time: Common Terminology Model (eg reconciling SNOMED / ICD / LOINC )?   

Also FHIR / OpenEHR collaboration (see Zulip discussion, particularly FHIR Questionnaires). Main work in reconciling lower level data types.   See https://chat.fhir.org/#narrow/channel/179174-openehr/topic/Transforming.20archetypes.20to.20Questionnaire.20and.20Logical.20models

Previous Meetings

2

Peter Williams

Rob Hausam

• 2026-02-18 - SNOMED on FHIR Meeting

• 2026-02-03 - SNOMED on FHIR Meeting

• 2026-01-14 - SNOMED on FHIR Meeting

New Spaces

2

All

Post link to new SNOMED on FHIR Space in chat:  SNOMED on FHIR

Other Meetings

10

Peter Williams

Rob Hausam

R6 Ballot currently ongoing (potentially multiple rounds - next round possibly July?). PJ notes no substantive changes to Terminology API/Resources for R6 after major changes to Concept Map in 4 → 5. Meds (doseage) sees changes. Closure operator and findMatches were taken out - did not achieve traction. WorkGroups being asked to generate change log going forwards. Incubator are IGs on a per workgroup basis. HL7 Int new CEO started Jan 19, 2026

HL7 Connectathon Jan 13 - 15 2026 (Virtual Eastern Time)

HL7 WG Meetings Jan 26 - 30 2026 (Virtual Eastern Time)

Future Events:

IHE Connectathon Brussels March 2026 see here

SI Business Meetings April 12 - 16 Vienna (Sunday pm meeting Upper Belvedere 2-3)

Vitalis Nordic Conference with Hackathon 4 - 7 May (request for TS track NPU → SNOMED → LOINC mapping)

HL7 Connectathon + WG Meetings 16 - 22 May 2026 Rotterdam

SNOMED International Business Meetings and Expo October Sydney

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

Items raised at last Wednesday Meeing

Peter Williams

See 2026-02-18 - SNOMED on FHIR Meeting

• Status of the FHIR IG support in Snowstorm: is now main focus since LOINC work has been completed. Currently upgrading connectathon server for IHE Connectathon 23 - 27 March

• SNOMED with FHIR guidance page. Group discussed aligning with current version and then having sections for earlier versions. Possible also to have completely separate pages per version, but this doesn’t help implementers work out what needs to change per version. Terminology (Resources + API) doesn’t change too much between R4 and R6 except for ConceptMap

• Peter Williams Will kick off April agenda and invite Rutt Lindström to present.

SNOMED Case significance FHIR

michael lawley

Case significance flag is inconsistent across releases.

Note that the actual codes themselves, being numbers, are case insensitive in our case.

GG chose to treat all descriptions as case insensitive. Ontoserver is always case sensitive. Ideal case might be to validate based on the description case significance flag (ML finds inconsistencies there - discuss further).

Feedback on Lab Report Demo

Kari Heinonen

Alejandro Lopez Osornio

EHDS Laboratory Diagnostic Report of SCT Implementation Demonstrator has gained some mentions e.g. in https://chat.fhir.org/#narrow/channel/242580-europe/topic/HL7.20EU.20Laboratory.20Report.20FHIR.20IG/near/570513050

Kevin Mayfield said “Its FHIR output is invalid. I added a Specimen and ServiceRequest to the report, this created a DiagnosticReport but the Specimen resource was attached to the specimen element (not as a reference) and the same occured with ServiceRequest being added to basedOn as a resource.”

KH: “to summarize: a) make output FHIR valid (maybe as an option to build a more complex document bundle as per EHDS Lab IG) and b) there seems to be interest to use demo to build "real-life" comparable (i.e. same data) examples for Observation Grouping discussion as normally each realm has these readily available only using their national flavour.”

2025-02-03

All

Discussion on case sensitivity as it relates to $validate-code

SNOMED CT National Editions and FHIR Validation

20

Janice Spence

See FreshDesk #57767

Null flavors in FHIR Observation

Kari

@Joanie Harper If test (code) is known, and the result (value) is not known, this can be representated with the DataAbsent element in observation. If there are no observations in a composition, it is possible to represent with an ObservationEmptyReason Flag (is it available in IPS?).

OpenEHR

Suzy Roy

Peter Jordan

 FHIR/openEHR data type reconciliation see Zulip.

Using SNOMED CT with HL7 Standards

20

Suzy Roy

Request received from HL7 that this working group take a more proactive role in keeping https://terminology.hl7.org/SNOMEDCT.html up to date.

From Reuben:   This page and similar ones for other external (to HL7) terminologies are managed as part of HL7 Terminology (THO).  Additionally, changes to these pages are handled as so Pro Forma changes rather than UTG's Consensus Review / Voting process which applies to internal HL7 terminology artifacts. With Pro Forma changes, a responsible committee approves the change. For this page (and the other Using X with HL7 Standards), the responsible committee is the HL7 Terminology Services Management Group (TSMG) which Carol, Jess, and I co-chair. TSMG has effectively replaced the former HL7 Terminology Authority (HTA). Lastly, TSMG will always consider input from the SNOMED-on-FHIR committee and the HL7 Terminology Infrastructure Work Group when deciding on which changes to this page to approve.

PJ note that "Using SNOMED CT with FHIR" page is actually already part of the R4 page and so cannot be changed.   Moving it out of the specification for R5 going forward allows for it to be changed independently of the main spec.

Explicit syntax for properties

10

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

Progress on FHIR Tx Ecosystem work in Snowstorm

10

TBC

Update on work to bring Snowstorm into line with FHIR Spec to allow participation in FHIR Tx Ecosystem.

Code in feature branch: https://github.com/IHTSDO/snowstorm/tree/feature/MAINT-2889

Available for review here (read-only instance): https://connectathon.snomedtools.org/fhir/CodeSystem?title=International%20Edition&_format=json  

Feedback here (request access): Google Sheet

Publishing expansion parameters on FHIR Implementation Guides

Rob Hausam michael lawley 

Peter Jordan (Unlicensed) 

Based on a question in Jira: https://jira.hl7.org/browse/FHIR-44629. Discussed in this group to understand if we have requirements for this change, and add them to the discussion.

• The valueset definition can include parameters that affect conformance and do not need to be expressed on the expansion level

  • If you use precomputed expansions, the parameters are already baked in

  • If you have access to a terminology server you can compute the expansion and may need the parameters

• Other parameters like "only active concepts" or language may be represented only in the expansion, and may be added to the IG

• RH may be better to leave parameters to the valueset definition

• Plan: see what we can feed back to the FHIR discussion ticket

  • ML offered to add to the ticket to explain that it was discussed, and we may need more information

Laboratory representation in EU groups

Rob Hausam 

Balance between the information model and the terminology model (postcoordination). LOINC SNOMED to Lab resources (orders and results), Service request, Diagnostic report, and Observation (specimen and method are the main attributes). Advanced cases like microbial susceptibility testing with references to antimicrobial substances, organisms, etc. Discussed possibilities for representing transformations in standard language. Experiences with transformations of the Situation with explicit context SNOMED concepts.

Question on use of multiple codings in a CodeableConcept

Jon Zammit 

Question on the use of multiple codes in a CodeableConcept, especially when multiple codes belong to the same CodeSystem

eg from spec https://hl7.org/fhir/datatypes.html#CodeableConcept specifically "The concept may be coded multiple times in different code systems (or even multiple times in the same code systems, where multiple forms are possible, such as with SNOMED CT)"

PWI gave example of potentially transmitting most specific concept and also (for non-SNOMED members) the closest ancestor to that concept that is also in the IPS free set.    But the specification pre-dates the IPS, so whoever wrote the above was thinking about something else.

KH suggested reviewing: https://chat.fhir.org/#narrow/channel/179202-terminology/topic/Multiple.20codes.20in.20CodeableConcept also "Another dimension of CodeableConcept question is IG conformance and profiles using 'magic codes' to identify structural parts. Usually this comes up pretty quickly in this area."

Sept 16th:

JZ: Why would we use multiple SNOMED concepts?

PJ, DK, ALO: It can include the National Edition code, an International Edition code, and the IPS terminology code; the codes should have the same meaning but different granularity, providing the best representation for each version

JZ: The question code element in https://build.fhir.org/questionnaire.html supports multiple codings, the group discusses possible use cases and reasons for this

No further discussions are needed for now.

Surfacing alternate identifiers as a property in $lookup

michael lawley 

Peter Jordan (Unlicensed) 

Peter Williams 

See Surfacing Alternate Identifier Values in FHIR ( See LOINC and NUVA Extensions)

2025-04-29 Group liked 'equivalentConcept' as it correctly identifies the relationship to the alternate code, and the fact that this is specifically a concept that is being pointed to.

2025-05-13 How to refer to the map/alternate identifier scheme (ML,KK,ALO)

Options:

• 1. Use the SCTID of the identifierSchemeId like in maps:

  • http://snomed.info/sct?fhir_cm=30051010000102

• 2. Use a different representation for alternate identifiers to reflect the difference in importance of an alternate identifier vs a map:

  • http://snomed.info/sct?fhir_cm=equivalentConcept

• In any case, translate operations can work OK with source and target URIs only

FHIR Questionnaire

Encoding issues

Alejandro Lopez Osornio 

NLM issue with double encoding of URI parameter

Worried that URI contains invalid characters for a URL, so needs to be encoded, eg ValueSet URI that contains an ampersand.

ML shouldn't need to encode a 2nd time, as the encoding on the URI ensures that it is valid.   Notes that technically speaking, ECLs in URIs should have the terms removed.

PJ Could use POST to avoid the need for URL encoding (ML you can't cache a POST)

A new thread discusses this in Zulip, and during the call ML identified the issue, an erroneously encoding of the / in the URI. See: https://chat.fhir.org/#narrow/channel/179166-implementers/topic/Percent-encode.20parameter.20value.20for.20.24expand.3F/with/515590039

Working out what version of SNOMED CT has been loaded on your terminology server.

Marie-Alexandra Lambot Rob Hausam 

When I request a SNOMED code from a terminology server, how do I know which Edition has been loaded?

Ontoserver makes

this available in the terminology capabilities statement (force the output to be json to avoid truncation)

https://r4.ontoserver.csiro.au/fhir/metadata?mode=terminology&_format=json

Find the object that contains 

• uri: "http://snomed.info/sct"

and then look for the version that is marked as the default:

Open

A bad way to find out from the International Edition is to look at the descriptions on the root concept 138875005 |SNOMED CT Concept|, one or more of which feature the effective time of the release.  

Common Terminology Model

(eg reconciling SNOMED / ICD / LOINC )

Peter Jordan (Unlicensed) 

RH Is this considering content or structure?  We express SNOMED CT (and therefore LOINC) in many different formats. Given that there are many formats, could there be a common one?    We already express all 3 in FHIR, with some loss of detail.

Reconciliation of datatypes probably too low level for a common model (necessary for implementation however).

Reconciliation of content would start with top level hierarchies, eg lab results appearing under < 363787002 |Observable entity (observable entity)|. ICD might approach this area with procedure codes.  

XiA -

Work package 4

Marie-Alexandra Lambot 

XiA project - what should be taught?  Goal: what competencies/skills should be attained for the various groups of users to work with SNOMED and FHIR in Europe. (Fhirly are already members).

Who are the stakeholders being targeted and what do they need to know to work with EHDS?  

PJ recommended reaching out to HL7-Belgium.  HL7 International - what courses are available?  https://darrendevitt.com/

Snowstorm for IG Tooling

Planned work to bring Snowstorm up to spec for use with IG Tooling.   PWI to check if project plan has been confirmed.

Broker should route requests to the appropriate server, once certified / verified / registered.   Each HL7 affiliate should host their own national extension.   See https://confluence.hl7.org/display/FHIR/Publishing+terminology+to+the+FHIR+Ecosystem

Links to question of LOINC Extension and how that would work with FHIR, given that LOINC is already available in it's own CodeSystem.  Suggestion that a LOINC Identifier used eg in ECL would be immediately expanded to be the LOINC SCTID (see bottom of this page: 6.1 Simple Expression Constraints )

Case significance

michael lawley 

Surfacing case significance.  Came about in the work done in AMT V4 where capitalisation was done to bring terms into line with the International Edition.   Validation was then failing as pre-existing terms were being supplied using the wrong case and this caused a matching failure.

Would this be best done via an Extension - eg on Concept.Designation which could appear as both on the CodeSystem and $expand

ML Case significance is part of the rules of the CodeSystem.   Note that the FHIR Spec allows for the case sensitivity to be determined by the CodeSystem itself.   PWI Notes that Snowstorm in general does case insensitive matching (Ontoserver is case sensitive - specifically in $validate-code) This has two parts:  1) correct behaviour in validate-code (ie check case where case has been specified to be significant) and 2) to tell the user what the case significance is so that they know when it is possible to modify the case of the term (and also for lexical operations like building narrative structures).

Next Steps:  CSIRO to propose an extension for review.

Checking position of the group: 

Open Question: Should / how should the CodeSystem-default be asserted / indicated in a ValueSet expansion (bearing in mind that it might contain codes from multiple different CodeSystems)

2024-11-12 ML Notes: Case Significance

1. No way for a CodeSystem to indicate whether display/designations are case-significant or not (to affect $validate-code behaviour)

2. For SNOMED, this varies on a designation by designation basis

3. For SNOMED, there are three possibilities:

       1. Case sensitive

       2. Case insensitive

       3. Initial character case insensitive

Proposal:

1. an additional (optional) element on CodeSystem to indicate the default / global behaviour. If no value, then defaults to case sensitive (safest option).

2. an extension on CodeSystem.concept.display, CodeSystem.concept.designation.value, ValueSet.expansion.contains.display, and ValueSet.expansion.designation.value to indicate the specific behaviour. If no extension, then defaults to CodeSystem’s default.

3. Also need a CodeSystem for the above three cases OR re-use the three SNOMED codes

4. SNOMED CT SHOULD assert Case insensitive as the default?

Group felt that case should not be considered during searching / filtering.   Should be checked for $validate-code and specifically fail.  Data needed in $lookup and $expand for use cases where text is compiled into narrative or post coordinated term.    Related question around how to validate diacritic marks (café).   PJ notes that in UCUM the codes themselves are case sensitive, but this discussion only relates to designations.  ML Question of case sensitive $validate-code should go to a bigger audience.

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.  DK NPU 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.

Tx Compatibility

Peter Jordan (Unlicensed) 

Kai Kewley 

Discussion on work being done to make Snowstorm compatible with Tx

https://chat.fhir.org/#narrow/stream/179202-terminology/topic/Terminology.20server.20requirements.20for.20IG.20builds.2E.2E.2E

1 month of effort "pencilled in" for Q2 2025.   Also interest from St Bart's Hospital.

Obtaining additional Description details.

Daniel Karlsson 

Ways to obtain Description SCTIDs.  There is an extension to allow this: https://build.fhir.org/ig/HL7/fhir-extensions//StructureDefinition-coding-sctdescid.html but is there a way to switch it on/off at runtime eg additional parameter on a $expand operation?

ML Ontoserver does not support FHIR extraction of description ids and aren't keen to (although some requests have been received in this direction).  SNOMED maintenance will be done via RF2, so IDs accessible that way.

Jon Zammit 

ECL Binding to Data Entry forms - picking up unwanted terms due to also searching text definitions.   Suggest skipping them as part of the FHIR VS expansion filter.

ECL (if it were possible to use it in this way) would let you move your term search earlier in the process and restrict to SYN and FSNs:  <  56265001 |Heart disease|  {{ term = "heart", type = (syn fsn) }}

MAINT-2665 raised so that default FHIR $expand filter behaviour will be to only search SYN + FSN, but we should clarify the ECL spec on this as well.  See https://build.fhir.org/valueset-operation-expand.html ML : Ontoserver puts text definitions into the definition field, does not treat as a description - see CodeSystem $lookup out parameter:  https://build.fhir.org/codesystem-operation-lookup.html (DL asks if we could have it out in a VS$expand.   ML suggested we could specify definition in the property input parameter (see also VS.expansion.property)).

Archive.

Translation in Code System Supplements

Daniel Karlsson 

michael lawley 

2024-08-06

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

Observation and Device Data

Marie-Alexandra Lambot 

michael lawley 

2024-08-06

MAL Belgium wants to exchange Continuous Glucose Monitoring data using FHIR, specifically, Percentage of time in set ranges was a difficulty.

ML Argonaut CGM project ongoing

https://chat.fhir.org/#narrow/stream/179175-argonaut/topic/CGM.20Project 

https://build.fhir.org/ig/HL7/cgm/

https://build.fhir.org/ig/HL7/cgm/StructureDefinition-cgm-summary-times-in-ranges.html

Document the use of an issue type to return incomplete validation

40

Peter Jordan (Unlicensed) 

michael lawley 

Daniel Karlsson 

HL7 Jira ticket: https://jira.hl7.org/browse/FHIR-44810

The group discussed the topic and documented the discussion in the HL7 Jira ticket: https://jira.hl7.org/browse/FHIR-44810?focusedCommentId=231490

UPDATE June 25 2024: Notes from HL7 WGM in May:  Attendees agreed that we'd like more feedback from the SNOMED on FHIR committee on how this would work in practice in all the cases where it would apply to SNOMED CT.  Input on whether or not machine processable responses should be supported would be appreciated as well.

TBD: Discuss in future calls with Kai Kewley and michael lawley present

2024-08-06: No changes on HL7 Jira ticket. Assigned to Grahame G.

Observations vs Questionnaires

Marie-Alexandra Lambot

Plans for patients in crisis (eg what can be done, who should be contacted, what does the patient accept).  Best way to capture in FHIR - CarePlan or Questionnaire?   Similarly for scales - each point on the scale is an observation.   

ML suggested using the questionnaire to capture the information and then transmit it via an Observation. Also see https://smartforms.csiro.au/dashboard/questionnaires - open source Questionnaire rendering with SDC support

ALO See https://build.fhir.org/ig/HL7/sdc/extraction.html.  Scores can also be computed.   See also 

https://lhcformbuilder.nlm.nih.gov/ and https://ihtsdo.github.io/sct-implementation-demonstrator/#/questionnaires

JZ Terminology Binding see Terminology Binding Principles

(MAL - Side discussion on documentation generation (click tracker with screenshot capture) - Datango.   What is Anne Randorff Højen using for Simplex user guide?)

MedicationRequest Question

20

Marie-Alexandra Lambot 

There are questions here currently regarding the Medication "line" (medication Statement I think in the international models) / Medication request / Medication dispense. One is, is there a way in FHIR to somehow link two medications to say that people have to take one drug X hours after the first one? 

How can we in MedicationRequest.dosage instruction express that a drug must be taken x hours after another drug which is in another medication line/Request? Can we somehow group two prescriptions to link them and give "global instructions" for both? Or would that pose other problems?

DK (update 31 July 2024): See also IG HL7 Europe FHIR IG for Medication Prescription and Dispense - https://confluence.hl7.org/display/HEU/Medication+Prescription+and+Dispense%2C+Edition+1 (FYI Marie-Alexandra Lambot )

General discussion on work being done in EU

6

Marie-Alexandra Lambot

Daniel Karlsson 

See https://build.fhir.org/ig/hl7-eu/laboratory/branches/master/index.html

https://github.com/hl7-eu/laboratory

https://confluence.hl7.org/display/HEU/Laboratory+Report+Implementation+Guide%2C+Edition+1

https://build.fhir.org/ig/hl7-eu/xpandh-hdr/

ML: https://csct.be/projects.html

https://nuva.mesvaccins.net/

2023-09-19 ML CSCT now has official "Not for Profit" status as an entity.

2024-05-29 RH The HL7 Europe Laboratory Report FHIR IG will be balloted as a universal IG either in Sep 2024 or Jan 2025.

2024-07-31 DK See also IG HL7 Europe FHIR IG for Medication Prescription and Dispense - https://confluence.hl7.org/display/HEU/Medication+Prescription+and+Dispense%2C+Edition+1 

Identifying Modules - is most dependant the right thing to do?

Jon Zammit 

Problem that changing the Canadian identifying module to the most dependant one (French Module) is not recognised by Snowstorm

Peter Williams Raise ticket to update https://github.com/IHTSDO/snowstorm/blob/master/src/main/resources/application.properties

The "most dependant module" idea doesn't continue to hold when we think about extensions that have multiple, equally dependant modules.   Also some external content (like LOINC) could be used by multiple countries and be the most dependant module, but could not be used as an identifier - it would no longer be unique.

2024-07-09 Review the guidance in the extensions practical guide to define how to select the identifying module, even when is not the most dependent module. The agreement of the group seems to be to separate the notion of package composition from module dependency. The terminology server will use the provided module as an identifier of packaged, which contents are defined elsewhere. The extension maintainer will choose which moduleId will identify his package, and needs to make this available to implementers. Maybe this is a use case for annotations. 

Alternative approach AP: NHS has created a composition module, that is created only for the purpose of referring to the other 5 NHS modules, and be used as the identifier of the package.

Model Binding

Jay Lyle 

Model Binding, specifically model binding for elements within resources (rather than values).

Previous binding discussions:   Bindings to FHIR Clinical Resources. See also terminology binding

See demo which shows various elements in FHIR resources and how those would be populated from a SNOMED concept:  https://ihtsdo.github.io/sct-implementation-demonstrator/#/context. but working back from that, we could identify the SNOMED Attribute Types, which are relevant for the various elements in each resource.

JL see https://hl7.org/fhir/R4/condition-mappings.html#sct-attr or, more challenging: https://build.fhir.org/observation-mappings.html#sct-attr

Also discussion on negation in Condition, Allergy and Family History (see 160266009 |No family history of clinical finding (situation)|)

Also on the subject of the purpose and value of putting time into this:  if mapped to the appropriate SNOMED Attribute Types in compatibility with the Concept Model, that would allow an automatic transformation to a Post Coordinated concept - or possibly identifying as a Pre-coordinated one.

New Slimline Agenda 

Peter Williams 

See discussion pages for links to archived discussion:  Discussions

Problem lists in FHIR

Marie-Alexandra Lambot 

How are Problem Lists (aka concern list) shared in FHIR? 

PJ Transfers of patient notes / records contain problem lists.   Suggestion to use Observations.

AP Shared https://developer.nhs.uk/apis/digital-maternity-1-0-0/explore_problems_list.html based on List Resource

Background reading: Medical Records That Guide And Teach also "Medicine in Denial" (also updated - 

"Ending Medicines Chronic Dysfunction")

Affiliate license

Peter Jordan (Unlicensed) 

Questions around the Affiliate license in Zulip 

See affiliate license - https://www.snomed.org/_files/ugd/900274_689013e9e0c74d23892abe9caee02612.pdf

2024-07-09 New section in IHTSDO Freshdesk with Licensing FAQs: https://ihtsdo.freshdesk.com/support/solutions/4000002199

Exposing Relationship Grouping in FHIR

Peter Jordan (Unlicensed) 

michael lawley 

Zulip discussion on exposing relationship role grouping: https://chat.fhir.org/#narrow/stream/179202-terminology/topic/SNOMED.20relationship.20groups

Ontoserver uses their own extension: https://ontoserver.csiro.au/docs/6/ext-subproperties-cs.html

OWL representation groups explicitly with 609096000 |Role group (attribute)|

ALO Since you already have access to the normal form as a property, role grouping could be determined from this.

Asserter / recorder

Marie-Alexandra Lambot 

How should we deal with the situation where the person entering data into some system may not be responsible for the record.

PJ See Immunization Performer - each one has an action and an actor

https://www.hl7.org/fhir/provenance.html ( fully featured & flexible but heavy handed approach)

See also https://www.hl7.org/fhir/R5/participant.html and https://build.fhir.org/procedure.html

R6 (unchanged from R5) states:  9.2.4.8 Use of Condition.asserter 
If the data enterer is different from the asserter and needs to be known, this could be captured using a Provenance instance pointing to the Condition. For example, it is possible that a nurse records the condition on behalf of a physician. The physician is taking responsibility, despite the nurse entering it into the medical record.

DK Would expect to see multiple Condition resources where multiple parties assert a diagnosis

JL See discussed list of possible participants https://confluence.hl7.org/display/CGP/Provenance+Domain also (DK) see ValueSet https://hl7.org/fhir/R5/valueset-participation-role-type.html

Group agreed that the current wording in the specification is unclear.

Introduction to SNOMED with FHIR YouTube recordings of Dev Days Presentations:

https://www.youtube.com/watch?v=40Lvv2t8OxU

https://www.youtube.com/watch?v=x6UqJtcJwmQ

https://www.youtube.com/watch?v=8cXRAtNoSvc

SNOMED Concept Model & Resources elements mapping

Jay Lyle 

Information on Mapping SNOMED Concept Model to FHIR Resource properties

Andrew Perry (Unlicensed) There is info in the FHIR home page: Bindings to FHIR Clinical Resources There discussions in termInfo about semantic overlaps but they were not exhaustive. UK has specific advice about what attributes to avoid.

Round table updates

Marie-Alexandra Lambot 

Belgium Update + TX IG Support Update - authorities looking for independence from HL7 servers, partially due to performance considerations.   RH Suggested self hosted TxFHIR.org server code (needs built locally unless Windows install, see https://github.com/HealthIntersections/fhirserver ) available (or Ontoserver of course - as of v6.15).

ML suggested:  See http://tx.fhir.org/tx-reg/ and https://github.com/FHIR/ig-registry/blob/master/tx-registry-doco.md for alternative terminology server support

MAL: Is every FHIR message validated, and if so, against a separate server?  RH Having the same discussion with US implementation - unsure of consensus.   Group discussion on: if a message fails validation, what are you going to do with it?  Quarantine (can then get stuck)?    Bounce back (not implemented?).   ML Usually systems are not synchronously coupled, so a message rejection is not possible. Watch out for CodeSystem updates eg change to display text for a code suddenly causing large volumes of rejections.  Also watch out for text in ValueSet definitions as it can also go out of date. PWI SNOMED-CT has the option to be more forgiving for inactive descriptions.   

Belgium (via Translation User Group) would like to inactivate descriptions of inactive concepts to help avoid apparent duplications.  ML Ontoserver will detect this and use "best case" instead eg most recently inactivated descriptions.

See also https://build.fhir.org/episodeofcare.html (unchanged since R4) collects together a set of temporally linked encounters.

Valueset Version Validation issue in IPS

Rob Hausam 

RH: IPS Guide has bindings to value sets expressed with the International Edition version. Validation of content with the Canadian edition fails, even if it refers to concepts in the international edition.

PJ: sharing version in the codeable concept is complex for validation

ML: using the international edition in the valueset definition is limiting in this setting

RH: Version is overloaded to represent edition + release 

Plan: Not using the version in the value set definition. Verify if the validator is firing appropriately. it should be a warning in some cases. What would be the guideline on wether to include version or not when sharing a codeable concept? Share both your national concept + the closest concept in the international edition?

How to package content IGs with Terminology IGs

Peter Jordan (Unlicensed) 

ML: The challenge of keeping them aligned

DK: we include valuesets but not coded systems in our IGs

FHIR Questionnaires and SNOMED Demo

Alejandro Lopez Osornio 

Demo: https://ihtsdo.github.io/sct-implementation-demonstrator/#/questionnaires

URI Resolution Update

Peter Williams 

Requirement to resolve URIs representing post-coordinated expressions.

See https://chat.fhir.org/#narrow/stream/179166-implementers/topic/The.20URL.20is.20not.20valid.20-.20Snomed-ct.20compositional.20grammar.20.7B.20.7D

ML Suggests resolving to a page that displayed information about that expression - formatted nicely, diagram? - and perhaps further capabilities, but not go as far as attempting to classify in the first instance.

ECL would return implicit valuesets

"Post Coordination is modeling and shouldn't be taken lightly" - DK

Incomplete Expansions

Peter Jordan (Unlicensed) 

Potential for marking the expansion of certain  valuesets as incomplete because theoretically, all possible Post Coordinated Expressions exist but are not included in the expansion.  See https://build.fhir.org/ig/HL7/fhir-extensions/StructureDefinition-valueset-unclosed.html

https://jira.hl7.org/browse/FHIR-40718

DK - flag excludePostCoordinated to include or not include post coordinated values would affect this.

Snowstorm Development Question

Peter Jordan (Unlicensed) 

Question on the future direction for Snowstorm

PWI : Potentially looking at horizontal scaling by separating out country instances on number of services.   Considering test suites eg Touchstone.   Also support for use with IG Tooling.  PJ suggests could look at Inferno (wrapper for FHIR Validator).

ALO : Snowstorm-lite would allow for quicker scaling with much reduced memory footprint, with a small number of limitations such as reduced ECL capability and restriction to single Snapshots.  See https://github.com/IHTSDO/snowstorm-lite

Update of the Implementation Course - Terminology Services Module

Jon Zammit 

Regarding Using SNOMED CT with HL7 Standards

• "Simple Map Reference Sets" link is now dead - replace with one of the directional maps?

• Since we can do this with any maps (eg Complex/Extended), could the language in this section be made more general. 

• "Where [sctid] is a value from the table above" need not be limited to the table above, could be any map reference set SCTID.

• In Snowstorm, check how the correlation id is being translated into the 'equivalence' ICD-10 coming back as 'unmatched' due to the values in the ICD-10 map.   In the case of the historical associations, we could populate the equivalence based on the association type

• How is the CTV3 map working?  In that map the target is a SNOMED CT code.  However, might be better use of our time to remove the CTV3 map rather than get it working.  Note that NHS UK were generating CTV3 codes until 2016 (mapping until 2020) so if SI codes are out of step with UK codes, then that's dangerously misaligned.

• Do we want to include the attribute value reference sets here, as the reason  for inactivation gives an indication of which historical association is going to be used.

• Check the implicit maps returned eg https://browser.ihtsdotools.org/fhir/ConceptMap?_format=json

DK: How do we express equivalence now?  Should that be done with two complementing simple directional maps, or would we use a complex map with a correlation type of equivalence?

Peter Williams Create HL7 Style tickets / SI Internal tickets for the required changes.

Alt Identifier File

Peter Williams 

Kai Kewley 

Using the Alternate Identifier File in implicit maps.

No refset is available.  Can we use the scheme id?

On non receipt of a scheme id, we discussed that all 'mapped' values could be returned?

So here for example, is the scheme &url=http://snomed.info/sct?fhir_cm=<scheme sctid> needed? It would cause issues by being looked up as a refset first, and code would have to be ready to fall back to also check scheme ids.

ML suggest we need the URL parameter to indicate that the alternate identifier file should be used.  Is there a URI for the Alternate Identifier File itself?  No.

The scheme id is more specific.  It is redundant because we already have the targetSystem URI.   Could it be used for anything else or confused with anything else if we tried to use it?  

URI suggestion:   http://snomed.info/sct?fhir_alt

This will return all scheme known in the alternate identifier map.   ^ requires that we have the target system URI as an annotation (or additional relationship) on the SNOMED schema concept.

So here fhir_alt follows the HL7 defined pattern as per fhir_cm

The targetSystem would need to mapped to the URI (annotation/additional relationship) which gives the URI for that scheme.  705114005 |LOINC Code System|.   The additional relationship file will need to be parsed for this metadata which is needed for the FHIR server to perform these mappings between URIs and Scheme SCTIDs.

Another Question:  the source and target imply a direction and the alt identifier file can be considered to be an equivalence (Equal in R4)

R4 (also  has Product that could be used to specify the Scheme as a return value, see https://hl7.org/fhir/R4/conceptmap.html

2024-02-20 ML Is FHIR clear itself on how alternate codes should work?  Not a problem at the CodeableConcept level (where multiple codes are expressed), but at the CodeSystem level so how would we see it in a $lookup (presumably as a property).  PJ Subsumption would need to work in the orginal codesystem.   PWI doesn't want to reference things like LOINC codes (NNNNN-N) in the SNOMED CodeSystem because at that point (if we were to add multiple external codeSystems) then we can't tell which alternate CodeSystem it originated in.  DK Languages Group defined ECL solution  for alternate identifiers including the schema eg LOINC#12345-6, see 6.1 Simple Expression Constraints PWI so that does seem like it could exist in the SNOMED CT namespace.  ML So if we looked up that code in SNOMED CodeSystem we'd get back the relevant SNOMED code (with a property of "AlternateIdentifier" as a Coding where the system would be "http://loinc.org", and the code 12345-6).   DK At this point we've removed the need to do a $translate operation at all (or do we support both?)

IG Tooling Compatibility

Requirements for making a Terminology Server compatible with IG Tooling

See Zulip discussion here:  https://chat.fhir.org/#narrow/stream/179202-terminology/topic/Terminology.20server.20requirements.20for.20IG.20builds.2E.2E.2E

2023-07-25

• michael lawley is implementing the requirements in Ontoserver

• Graeme is preparing the Terminology Server registry, probably a JSON document, that would make available different terminology servers, listing the capabilities, including which code systems on each server

2023-08-22

• michael lawley the scope has expanded, advancing on the implementation. The registry will document which terminology server meet requirements, it is a centralized resource, maintained by HL7. There is document that describes this. An implementation guide developer would use this information to choose a compatible terminology server as the backend of the IG valuesets. There is a test suite that servers can apply to demonstrate compatibility, Graeme will be the curator of the list, the submission process for a new server is under development.

2023-10-03 ML Ontoserver still a work in progress in this area.

Observables model

michael lawley 

Question on the Observables Model - was discussed in both the MAG and the EAG.   Yongsheng Gao currently looking at proposals and next discussion will be at all staff meeting in June.

There was an inconsistent role grouping pattern in the observables, and the question was trying to find the reason for this. This is being evaluated.

Peter Williams There is a decision to move to the grouped pattern

Andrew Perry (Unlicensed) looking for opportunities to contribute to the observables and LOINC modeling decisions

2023-09-19 Update:  Direction of travel here suggests moving to have all attributes in a single role group, but preparatory hierarchy movements will be required first - Evaluation Procedures moving to Observables.  Discussion expected at October MAG meeting, followed by a briefing note if no major objections raised.   AP UK have concerns about problems caused with existing counterparts between the two subhierarchies.  UK did respond to RFC last week.

2023-10-03 SI responding to briefing note feedback (including encouragement from UK to engage as a matter of priority).  Discussion expected in both MAG and EAG at October Business Meetings. Two Schools of Thought:  LOINC style single observable hierarchy (order / result) vs. procedure + observable pairs for expressing ordering and results.

Post R5 Concept Map - support for SNOMED Map features.

michael lawley 

Concept maps and SNOMED Maps  - how to materialize as both R4 and R5.

Metadata needed:  target CodeSystem URI,  source and target ValueSets.

Do we assume that a simple map is an equivalence.

For complex maps, how are the additional fields represented?   Eg in property, dependsOn and product (these are typed).   See 5.2.3.3 Complex and Extended Map from SNOMED CT Reference Sets  

CC Kai Kewley 

Update 2023-06-13 Now working in confluence Concept Map in R5

2023-07-11 Work being done (ML) around clarity and specification for the parameters used in implicit Concept Maps.

2023-07-25 michael lawley and Dion had a discussion on metadata and put together a proposal of a JSON based metadata, presumably to be presented to the MAG (clarified 2023-10-03)

Peter Williams Add to FHIR Agenda for October meeting and floating topic for MAG also.

2024-02-14 DK Enquired on status here.  KK has coded some support in R4 but uses comma delimited messaging.   ML Using extension to allow properties in R4 (fully available in R5).  See extension:  http://hl7.org/fhir/5.0/StructureDefinition/extension-ConceptMap.group.element.target.property

See example 1 and example 2 shows multiple groups matching.

Demos showing machine processing of ICD-10 rules:

https://github.com/IHTSDO/snomed-to-icd-10-mapper

https://ihtsdo.github.io/iid-icd-maps/

Discussion on whether or not the Terminology Server should have responsibility for applying the values to the rules to fully identify the correct target of the $translate operation. DK would like to see choice for client to calculate the rules.

2024-02-20 DK Sweden looking for FHIR based SNOMED to ICD-10 map.  Vendor had decided against FHIR Concept map and implemented a proprietary solution (although if standard existed, they might have gone that way, and would have been an R5 solution if so)

Expand Alliance

Marie-Alexandra Lambot 

XpanDH - Expand Alliance European Project.  Interoperability in Europe, targeting providing 6 x 40 hours of medical interoperability training to 40 students to fill gaps in existing offerings.  HL7 Europe (consisting of all HL7 European country affiliates) also participating.   

2023-05-30 Submission made (SNOMED International is a co-partner).  Response expected by the end of the Summer.

2023-10-03 ML News update on course proposals expected for November.  See https://cordis.europa.eu/project/id/101095594

Language behaviour compliance in Snowstorm

michael lawley 

Kai Kewley 

BCP-47 requires a dash every 8 digits so SCTIDs need to be broken up to be compliant.

Also the "x-sctlang" is required. 

Also discussed GG's request to Kai Kewley in the behaviour around language headers and how they interact with the displayLanguage in the HTTP GET request.

R5 changes suggested around specifying language using BCP-47 

Rob Hausam 

Daniel Karlsson 

See Tuesday meeting item #6

Changes for R5  and check on use of dialect in x form in ECL Specification Appendix C:  Appendix C - Dialect Aliases

Note that where a language reference set pulls from more than one language, the BCP-47  tag could potentially missing out the <lang> element and start directly with "x-".  Options for referring to multiple languages: could be done either with a * (see https://developer.mozilla.org/en-US/docs/Web/HTTP/Headers/Accept-Language#syntax ) or with a comma separated list to indicate a priority order (although this isn't supported by the FHIR parameter (unless the server went out of it's way to allow for this), or use the accept-language header).  Use case is in the displayLanguage input parameter to a ValueSet $expand operation

Peter Williams This extra detail should be filled into FHIR-languages to avoid overloading/over complicating the HL7 page.

2022-08-31 ML CSIRO attempting to get R5 compliant Ontoserver ready in time for HL7 Connectathon.

2022-10-04 With this page moving to terminology.hl7.org it is no longer subject to the ballot process.  Instead a "TSMG" ticket should be created.  Daniel Karlsson and Rob Hausam will progress this. 

Rob Hausam 

Also tracking R5 changes to concept map - see http://build.fhir.org/valueset-concept-map-relationship.html.   Peter Williams to check SI intention for R5 compliance.

2022-10-18 DK EHealth Working Group on Semantics - discussion on cross border infrastructure based on CDA.  Suggestion that it could move to FHIR for new specifications/developments eg Lab Reports.

2022-11-02 RH Rob will check the status and how we can help it move

2023-02-07 RH R5 Ballot is complete.   Deadline to complete resolutions is Feb 24th.   Expectation to publish late April / early May.

2023-03-07: RH R5 going through QA currently. Some last-minute changes in ConceptMap: RH change in relationship types, new ValueSet to remove ambiguity. Directions of maps (very) explicit. No-map situation simplification. Element name changes. Choice datatypes in more places. ML property, dependsOn and product clarification. E.g. property is used in implicit ConceptMaps based on SNOMED complex maps. http://hl7.org/fhir/5.0.0-draft-final/conceptmap.html 

2023-07-11 ML Added UP ticket - https://jira.hl7.org/browse/UP-436 (Unified Terminology Governance Project)

Language Reference Sets in FHIR

All

Mechanisms for working with Languages

Designation extension

24 August DK Added pull request to Snowstorm  here

Implementation by ML using existing fields and specifying LangRefset in displayLanguage parameter with "preferredForLanguage" code and wildcard  Eg https://r4.ontoserver.csiro.au/fhir/ValueSet/$expand?displayLanguage=*-x-sctlang-20581000-087109&_format=json&url=http://snomed.info/sct/20611000087101?fhir_vs=ecl/160303001&includeDesignations=true

Oct 5 Release of Ontoserver 6.5.0 which includes support for language reference sets as above.

Peter Williamsdocument examples using live Snowstorm instance

Next Steps: How to promote - could we present at a Vocab call?   (1530 ET Thursdays - may clash with SI Languages call)

8 Feb 2022 DK added Designation Extension into the SNOMED on FHIR IG see http://build.fhir.org/ig/IHTSDO/snomed-ig/StructureDefinition-designation-use-context.html

MRCM in FHIR

Machine Readable Concept Model (applies to both pre and post coordinated content)

Kai Kewley 

MRCM is needed for writing good ECL and also for writing 'good' Post coordinated expressions.

Going forward:  suggestion that PJ and RH expose both the MRCM and the capabilities of ECL 2.0 with the wider HL7 and FHIR Communities.  See slides on ECL 2.0 here.  ML more generally this is a refinement axis which is represented as two things - the attribute and the range of values that that attribute can take.

Peter Williams make a note of this in the IG

2022-11-1 ECL 2.0 can retrieve MRCM refsets content, the question is how to return them as FHIR resources (structure map?)

Using implicit concept maps may be an option to add operations such as get acceptable attributes or get range

(note SNOMED is the only CodeSystem that uses implicit concept maps, wording around that is changing, see https://jira.hl7.org/browse/FHIR-39266 )

Alejandro Lopez Osornio and Kai Kewley will draft a demo.

SNOMED FHIR Implementation Guide

Peter Williams

Implementation Guide for using SNOMED CT with FHIR.

IG Documentation: http://build.fhir.org/ig/FHIR/ig-guidance/index.html

Also look at the sample IG https://github.com/fhir/sample-ig see build http://build.fhir.org/ig/FHIR/sample-ig/

Rob Hausam to speak to Lloyd about extending the base template as per http://build.fhir.org/ig/FHIR/ig-guidance/template.html Update 24 March: Documentation on this is "TODO"

Peter Williams FHIR core content to be copied over to Snowstorm instance.

TODOS 

• Check build issues http://build.fhir.org/ig/IHTSDO/snomed-ig/qa.html    Update 2022-06-20 Tooling currently giving a null pointer, see https://build.fhir.org/ig/IHTSDO/snomed-ig/failure/build.log  asked question in Zulip  See https://chat.fhir.org/#narrow/stream/179252-IG-creation/topic/Null.20pointer.20in.20ValueSetRenderer   

• Note page to manually execute build through HL7 Tooling: https://fhir.github.io/auto-ig-builder/builds.html

• Rerun locally with latest tooling (also sushi)

• Run with local snowstorm provided as Tx

• See Mark Kramer presentation   https://www.youtube.com/watch?v=OmcSuAMf20s  Also https://fshschool.org/ 

• CONTENT! 

• Merge in DUC branch (Designation Use Context) with a view to implementing in a branch of Snowstorm and making available via connectathon.ihtsdotools.org

• Clean up other branches

• Check templates are up to date - should now be self updating, see https://github.com/FHIR/sample-ig (fsh may ask to update this structure).   Sushi sending out information about new format (PJ says leading whitespace is now significant).

• ReadMe should provide links for Publisher tooling

• Add discussion on Refset / IN (see above)

• Provide link to it in http://build.fhir.org/snomedct.html and discuss further socializing.

• TerminologyCapabilities caching is overly aggressive.

• Added 2022-08-23 Discuss ownership, hosting and copyright (joint copyright with HL7).  Source will be hosted in GitHub, pull requests will be welcome with this group acting as gatekeepers (reviewers) for that?   Suzy Roy would the wording of our original collaboration be helpful here?

2022-11-1: No news, check in the next call.

2022-11-15  Suggestion to set page per meeting list to work through.  Setting up one or two HTML style pages that could then be copied and modified and then use meetings to tackle more difficult content and review.  Finding best publishing location, cross referenced between https://terminology.hl7.org/SNOMEDCT.html

Pairings - Kai, Peter, Marie, Daniel, Rob

Top Topics

• What are the various Resources in terms of how they relate to SNOMED CT (Link to Follow the yellow brick code presentation).  

• ECL in FHIR (intensional ValueSets being less brittle)

• Languages

• Terminology Binding (General Approaches)

• IPS (GPS)

• FAQs eg how to recover historical assertions using Map

• Post Coordination & Transformation

• Relevant changes in R5 eg Concept Map (correlation changes)

2022-11-29

Example markdown page that could be copied and modified:  https://github.com/IHTSDO/snomed-ig/blob/master/input/pagecontent/sct_specific_behaviours.md

Work to be presented for 13 December (payment will be made in Glory^tm)

Peter & Kai - ECL in FHIR  (Update:   Used https://hackmd.io/  for collaborative markdown editing. )

Daniel & Marie - Allergy & Intolerance : (Update: Menu item added for extensions, confirmed examples are useful and appropriate for the Allergy Guide. )

Rob - IPS

Peter Williams contact Ole Vage & Feijke re Translation Group and contributing to IG relating to use of languages in FHIR (complete 2023-10-16)

2022-12-13 ECL Page reviewed - MarkDown not displaying the same as it did the IDE, revisit.

Looking for some more structure that could be applied to the apparently unordered list of ValueSets (which is machine generated).  Any documentation on how to do that would be appreciated.   Other IG's we could compare to are : https://build.fhir.org/ig/HL7/US-Core/terminology.html & http://build.fhir.org/ig/HL7/fhir-ips/  ( also http://build.fhir.org/ig/HL7/fhir-ips/terminology.html )

2023-02-07 MAL work for Allergy Implementation Guide (which the SNOMED IG will link to) see SNOMED CT Clinical Implementation Guide for Allergy, Hypersensitivity and Intolerance

2023-02-21 DK Work done for languages - https://build.fhir.org/ig/danka74/snomed-ig/branches/languages/  Discussion about overloading of parameter for both display language and search language.   Checking behaviour around fall-back on displayed terms (eg context specific → national language → English).   For example, display parameter being a comma separated list (which has a defined order, unlike repeating the same parameter multiple times (also not allowed in the spec)).

2023-10-16 PWI Update:  We had a note to follow up on https://www.hl7.org/fhir/R4/valueset-animal-breeds.html as these have mostly been inactivated and moved to the Veterinary Extension.   In following up, it was determind that this valueset is no longer present in the FHIR core as of R5.

Expanding ValueSets across multiple Editions.

Discussion on * version wildcard. (relates to a Zulip discussion on expanding a ValueSet against multiple editions to give a superset?)  DK How could we specify the latest version of multiple modules.   Answer http://snomed.info/sct/*   (ie not specifying the version) or http://snomed.info/sct/*/version/*  to include concepts from previous versions.

For use in the module / version URI.   Existing workaround is to use multiple include elements for each version.

7 Sept ML Sticking point - what do we do with incompatible properties eg active/inactive between two different versions - the most recent?

Use case: primarily being able to validate codes that might exist in different editions.   Secondarily, being able to validate code received in a historical record ie where codes were valid at time of data entry.

25 Jan 2022: Snowstorm will already look across all Editions loaded when a codesystem version is not specified, eg:  https://browser.ihtsdotools.org/fhir/CodeSystem/$validate-code?coding=http://snomed.info/sct|443971000124108 only exists in the US Edition.  (See also the History proposals for ECL)

Peter Williamsdocument Snowstorm multi-edition validation in IG

2022-05-17 ML Ontoserver supports ValueSets that draw from more than one version, so you could use that to compute the difference between one version and another.

2022-11-1: DK: Snowstorm does not yet support multiple include elements in different versions for the SNOMED code system. ML: The semantic is not yet clear, how to decide in which versions you check properties, parents, etc. Run separately for all inclusions and join the results. May need to understand better the use cases.

Michael Chu - let's discuss.

Any Other Business

2023-10-03 ML working on registration of congenital abnormalities - is there a way to group disorders (eg as part of a syndrome), specifically in the Condition Resource to (See Condition Related Extension in R4 http://hl7.org/fhir/R4B/extension-condition-related.html / http://hl7.org/fhir/extensions/StructureDefinition-condition-related.html )   See https://hl7.org/fhir/extensions/extension-registry.html  also condition-dueto.  JC Syndrome is just a grouper name, it doesn't "cause" the manifestations as such.

SNOMED Family of Languages

Peter Jordan (Unlicensed)

michael lawley

Impact of proposed changes (eg text searching in ECL) on FHIR. Questions around which language reference sets to use when there are multiple, especially partial/overriding context (referred to MAG for discussion)

8 Sept The FHIR specification does not specify a particular version of ECL, so we assume the latest.  Any enhancements added to ECL will be immediately relevant and available in FHIR.   Note that these latest additions while targeting descriptions are a concept filter, so display options (language etc) will affect the output of those concepts.   How about the filter parameter though, especially since ECL wo (ld allow multiple filters in multiple/different languages.

michael lawley Suggested ticket: Parent and Child properties to (optionally?) support the Coding type.

Specify CodeSystem in FSH

Daniel Karlsson

FSH apparently has no way of specifying the version of a CodeSystem. Daniel checking the ANTLR spec. https://github.com/FHIR/sushi/issues/473

API for FHIR Resource ↔ Post coordinated expression mapping

Peter Williams

API for FHIR Resource to SNOMED Expression

Daniel Karlsson Thought there might be some documentation from CIMI on this. Also notes from DMarkwell about constructor bindings.

Peter Williams Pull these notes into confluence - can we mention it in the IG?

Looking up an SCTID in an unknown module

Peter Williams

Problems when dependencies do not align. Multiple code system resources represent multiple editions / versions.

ML: See code parameter to code system search. Should return code systems (ie versions) where that code is defined. International concepts would appear in every edition known to the server.

eg /CodeSystem?system=htp://snomed.info/sct&code=12345678&_elements=version

Peter Williams Ticket implementing this lookup. Note that this could be implemented more generally for lookups of http://snomed.info/id/<SCTID> where the SCTID exists in an extension. Done - see STORM-262.

GPS

See Discussion on Global Patient Set (GPS)

FHIR Shorthand

michael lawley

https://github.com/HL7/fhir-shorthand/wiki

https://build.fhir.org/ig/HL7/fhir-shorthand/FSHQuickReference.pdf

Tooling: https://github.com/FHIR/sushi

$lookup operation - properties returned

Peter Jordan (Unlicensed)

Using http://ontoserver.csiro.au/vstool/  I noticed that both Ontoserver and SnowStorm return a SNOMED CT $lookup property for effectiveTime, which I don't see listed, as one of the SNOMED CT properties in the FHIR R4 specification at http://hl7.org/fhir/snomedct.html. Should we create a Jira TIcket to add this?

Completed - https://jira.hl7.org/browse/FHIR-26555

Use of url parameter

Peter Williams

CodeSystem "class vs instance" in url parameter between CodeSystem and ValueSet operations.

CodeSystem is understood.

In Valueset, url is the ValueSet url for example url = http://snomed.info/sct?fhir_vs= allows for the version URI to be used as stated in https://build.fhir.org/snomedct.html The base URL is either http://snomed.info/sct 

The ValueSet version valueSetVersion is just some string identifier eg a timestamp or 0.1.0

ECL in the Valueset Expression Extension

Rob Hausam

Check whether SNOMED ECL is (or should be) registered as a MIME type (as per RFC 4289/BCP 13), or alternatively added to the expression-language code system and value set, for use in the valueset-expression extension used with the ValueSet resource.

For example, HL7 have registered application/json+fhir

This is useful for a ValueSet extension which allows any language to be used to define the selection criteria for an intensional definition using a MIME type. This group has no current reason to use that extension given the existing core specification support for implicit ValueSet definition and the support within the compose element.

RDF community may have an interest.

Update 2 June RH: Existing small valueset extended in BCP13 (existing known codes could be published as a CodeFragment). Vocab Working Group discussion ongoing.

Behaviour on Lookup

What properties are returned?

Discussion: Both Ontoserver and Snowstorm are returning EffectiveTime which is not listed here (unlike other SNOMED specifics): https://build.fhir.org/snomedct.html

Peter Jordan (Unlicensed) to raise a Jira ticket to ask for this to be returned - completed https://jira.hl7.org/browse/FHIR-26555

Point of interest: Grahame's server returns a copyright property.

Update 7 April - Question about whether this is required / desirable?

Terminology Capabilities

michael lawley

Terminology Capabilities: Default SNOMED Edition for a Server. Suggestion to invite Graham for a wider discussion. Resource is still at maturity 0.

11 August The resource is based on instances of code systems. Difficult to make statements about code systems generally, or specific SNOMED editions, etc. Will start a Zulip discussion on this. michael lawley Then potentially invite Grahame for a future discussion?

25 August It has been agreed that this resource will now have maturity level 1

New parameters proposed for streamlining operation of expand and validate code

Grahame Grieve

See https://chat.fhir.org/#narrow/stream/179202-terminology/topic/tx.2Efhir.2Eorg.20New.20parameters.20for.20.24expand.20.26.20.24validate-code

8 Sept 20 Is there a Jira ticket ?   Rob says Grahame implemented this.

12 Jan:  RH update made to GG Server.   Documentation (assuming required) still outstanding.

FHIR Server Federation

michael lawley

Use case for fall back lookup when server does not know the answer to any particular question eg a façade server which has knowledge of all services it could potentially delegate to.

Aug 25: New capabilities in HAPI to allow delegation to an external terminology server.