2026-04-12 - SNOMED on FHIR Meeting
11:00 UTC Sunday 12 April 2026
In Person & Online Andaz Belvedere, Vienna
Upper Belvedere 2-3
Objectives
FHIR Terminology Services and Resources
FHIR Profiles & Terminology Binding
Meeting Details
Online: https://snomed.zoom.us/my/snomedhl7?pwd=UCtmRkdHZ3pVNDB1MnJuZmg2b3hUZz09
Passcode (not required when using link above): 32075
Chat: public-snomedintl.slack.com # snomed-hl7-fhir (ask for invite!)
Zulip Chat: https://chat.fhir.org/#narrow/stream/179202-terminology
Attendees
Staff:
Apologies
Meeting Recordings
https://drive.google.com/drive/folders/1puHQHB-KM9fYK9tymCjWpY0T9Z39iHOX
Discussion items
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 NB Will cancel meeting on Wed Apr 15, 2026 |
| 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:IHE Connectathon Brussels March 2026 see here Future Events: 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). Hackathon 8 May
HL7 Int. Connectathon + WG Meetings 16 - 22 May 2026 Rotterdam. openEHR and HL7 12 – May 13 Converge and collaborate https://openehr.org/event/converge-and-collaborate-openehr-and-hl7/ WHO/HQ 25 - 26 May 2026 - Geneva ICD-11 FHIR Connectathon https://indico.un.org/event/1022860/ 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 |
| 5 | Update on collaboration | 20 | Suzy Roy | |
| 6 | Round Table Introductions & Updates |
| All | Austria - using diagnostic codes starting this year. Australia - SPARKED Accelerator project - AU Patient Summary, E-Requesting, discussions around representation of Encounter. CSIRO - HL7 Australia - AU Base & Core IGs. Governance and Operations Manual. Terminology WorkGroup Germany - New infrastructure and projects emerging at National level. IQVIA (B2i) - Belgium - Canada - Working with Valuesets (translations). GR notes they also use additional relationships in drug related content. Estonia - Longer timescales than anticipated. 1.5 years of Ontoserver National and Healthcare Provider integration. CDA V3 migrating to FHIR, first services running. Health strategy features both FHIR and SNOMED CT. Europe EEHRxF - Finland - KH SCT work on gov.agency side is about some limited subsets/clinical use cases; mostly using mapping of national codes to SCT. Some observable movement for sector as a whole around e.g. Nordics collaboration and getting Ontoserver experience. France - Hong Kong - Using HL7 for data exchange, moving to FHIR Mapping. Terminology server switched to Snowstorm, mostly as browser. ICD-11 working (internally) on mapping to local terminology. HL7 International - Working on closing on R6 (moving to that will be next year’s challenge). Tx Ecosystem looking to generally raise the bar (currently only 2 server participating). Seeking balance between specification and allowing implementations to decide. India - Malaysia - Working with HL7 International. Starting to work on FHIR Imp Plan with SNOMED CT Netherlands - EHDS. Previously Clinical Building Blocks suggested for use but get implemented in different ways, now conforming to FHIR/OpenEHR. National Test & Validation Center in operation. NTS includes Patient Friendly Terms. New Zealand - Norway - Also working towards National Terminology Server. Also EHDS work. Discussion around reimbursement. Sweden - Setting up SnowOwl National Terminology Server. EHDS compliance. DK Regulatory comitology process (agreement on specifications). Several new IGs, tested at connectathon. HL7 Sweden - Ontoserver running to produce IGs with local content. Switzerland - SNOMED International - Multiple resources now working on Snowstorm Tx Ecosystem. Refreshed HL7 International collaboration agreement. Implementation Support Team guide towards FHIR Spain - South Korea - NRC KHIS (MoH) Developing KRCDI KR-Core using SNOMED CT (currently working on Procedures) TermMed - Publishing Spanish Edition and LOINC Extension translated to Spanish. United Kingdom - Pilot for Pathology Messaging Standard in General Practice (replaces 25 y/o standard) is EU compliant. Dedalus - Working with Canada and Ireland & UK. Interest (see below) on providing ‘member of’ details in $lookup response. United States - Gravity have submitted pre-coord Procedures resources, reason for procedure available as a separate field. LB would like to see SI provide less fully specified observable entities, to allow for fields in the information model to be meaningfully populated. GR makes point that the decisions taken at the NRC level are very different (situation on the ground) from those made at the International level. Regenstrief - (Stan Huff) Continue to work on LOINC Ontology (SNOMED Extension, now 2.82 ~45K concepts ie 98% real world usage coverage), transitioning from SI staff to RI. Looking to shift to monthly releases of LOINC. Also interested in representing genomics data (with HL7 Clinical Genetics group). Psychosocial questionnaires. |
| 7 | ECL Core |
| Kai Kewley | Cut down specification of ECL for reasonable implementation https://docs.google.com/presentation/d/1gxN6htJh86L11zGlDCfERDc8iqmnXVz-bum3CUon5m4/edit?usp=sharing |
| 8 | FHIR based tools |
| Dion McMurtrie Alejandro Lopez Osornio michael lawley | Demo of FHIR based tooling - https://aehrc.github.io/codeagogo/ and https://aehrc.github.io/ecl-lsp/ ALO: EHR Lab now connects directly to FHIR resource servers, like the public hapi for clinical content ML: https://www.fhir.org/VCL/ - https://build.fhir.org/ig/FHIR/ig-guidance/vcl.html See also https://fhir.org/VCL/ |
| 9 | Federated Distribution |
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| 10 | Membership as a property of a Concept |
| Dougal Flemming | Representing Refset Membership in initial $lookup of a concept - exposing as properties. KK notes that this is not unique to SNOMED - Valueset and concept map membership. ML considers this to be an expensive question to answer. |
| 11 | Effective Time |
| Peter Williams Kai Kewley michael lawley Peter Jordan | Continued from 2026-04-07 , also earlier discussion page Use of effective time parameter in $lookup Rendering Effective Time in FHIR $lookup operation. See Current positions: KKE change spec to String, PWI change spec and (Snowstorm) output to Date YYYY-MM-DD, ML change (Snowstorm) output to DateTime (h/m/s being optional). See Release File Specification - indicates time should not be used. |
| 12 | 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 |
| 13 | HL7 Page Using SNOMED CT with FHIR | 30 | Reuben Daniels Suzy Roy Peter Williams | 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.
https://docs.google.com/document/d/1zZuzliwL_PL0S7HMmaQrEj2-JJP-6Y2PccIFpF5cp6Q/edit?tab=t.0 |
| 14 | 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 |
| 15 | 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 |
| 16 | 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 |
| 17 | Parameterized ValueSets |
| Linda Bird (Unlicensed) 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. |
| 18 | Tx Ecosystem |
| Daniel Karlsson | ML Owner of extension gets to say what the authoritative source for that extension is. Registration (after proving conformance) is done via a json file - pull request to a GitHub repository |
| 19 | 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. |
| 20 | Concept Maps |
| All |
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| 21 | 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 |
| 22 | 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. |
| 23 | Magic Codes Zulip Discussion |
| Peter Williams Daniel Karlsson Rob Hausam | Magic Codes and Observable Entities as Questions and Clinical Findings as Answers |
| 24 | Support for Clinicians in using Information Models |
| Kusal Wijayaweera (Unlicensed) | Suggested resources: Introduction - Clinical Reference Groups https://confluence.ihtsdotools.org/display/CP SNOMED CT Clinical Implementation Guide for Allergy, Hypersensitivity and Intolerance |
| 25 | 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. |
| 26 | 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 (Unlicensed) 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' |
| 27 | Question on de-labelling allergies |
| Kusal Wijayaweera (Unlicensed) | 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 |
| 28 | HL7 and OpenEHR |
| Maryam Razavi (Unlicensed) Alejandro Lopez Osornio | |
| 29 | 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. |
| 30 | 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 |
| 31 | 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” |
| 32 | Resources for Allergy Intolerance / Adverse Events |
| Kusal Wijayaweera (Unlicensed) | 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 |
| 33 | How to handle ad-hoc post coordination in medical records |
| Kusal Wijayaweera (Unlicensed) | 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. |
| 34 | 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. |
| 35 | MRCM in FHIR |
| Linda Bird (Unlicensed)
| 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. |
| 36 | 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. Discussion on adding / removing modules to / from packages. Check on license conditions allowing for automatic promotion to ensure interoperability. Discussion on expansion related to 5.2.1.7 Query Specification Reference Set. ML Could we try to expand the referenced component id, ie look in this refset if no refset members are initially encountered? MLO Canada is already doing this and they have pre-expanded simple reference sets. KK Snowstorm does not use this reference set. LB An extended version of this refset has been drafted which allows the substrate to be specified. |
| 37 | New Slimline Agenda | 5 | Peter Williams | See discussion pages for links to archived discussion: Discussions |
| 38 | Post Coordination |
| Kai Kewley | Moved in from "Potential Topics": API for FHIR Resource to SNOMED Expression See also discussion on URIs for PCEs. 2024-03-05 - SNOMED on FHIR Meeting (TS & TB) |
| 39 | Additional information from ComplexMap $translate |
| Daniel Karlsson | ICD-10 Complex Map in ConceptMap$translate (see agenda item 18 2024-03-05 - SNOMED on FHIR Meeting (TS & TB) ) DK Suggests using match.product for each additional item with a URI for each column in refset as per 2.6 URIs for Properties KK The R4 Products are flat and various ICD-10 rules are grouped. Example here: https://snowstorm.ihtsdotools.org/fhir/ConceptMap/$translate?code=421671002&system=http://snomed.info/sct&targetsystem=http://hl7.org/fhir/sid/icd-10 |
| 40 | FHIR Resource cross field validation | 10 | Marie-Alexandra Lambot
| Question: Can we do cross field validation of FHIR resources, to restrict valueset available for one element dependent on the value entered in some other field. DK Do this using "Invariants". See https://build.fhir.org/conformance-rules.html and https://build.fhir.org/profiling.html#slicing (complex approach!) ALO FHIR Questionnaires have more support for cross field rules. LB - would specify this in the Implementation Guide with the specific rules. |
| 41 |
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| stefan.schulz (Unlicensed) | ValueSets eg for procedures which recommend SNOMED CT codes that have been retired. ML: ValueSets described via enumeration will need to be kept updated. The party that specified the ValueSet is primarily responsible for maintenance. RC: License requirements do imply that SNOMED CT versions should be kept up to date in systems. |
| 42 | FHIR in the new SNOMED Implementation course |
| Marie-Alexandra Lambot Kath Priest | The new implementation course could focus on SNOMED + FHIR, and transformations between information models, using maybe the Allergy demonstrator as an example. Maybe adding consideration on adding LOINC concepts, like the allergy test using LOINC (Observation in FHIR). Suggestions: add onset to reactions (date), and use problems already recorded for reactions manifestations, and vice-versa. Helpful Introduction Videos: Introduction to SNOMED with FHIR YouTube recordings of Dev Days Presentations: https://www.youtube.com/watch?v=40Lvv2t8OxU |
| 43 | April 2024 Business Meeting General Discussion Topics |
| Ronald Cornet (Unlicensed) michael lawley | FHIR for Terminology vs FHIR for Patient Records - eg for cohort identification. See https://www.hl7.org/fhir/search.html#modifierin can try out on https://hapi.fhir.org/ Also CSIRO Pathling server for analytics Navigational ValueSets - how can you express hierarchy and/or grouping in a ValueSet expansion? Nested code can be used to show hierarchy (navigational concept could be represented as blank). Question is more about how you initially input that structure such that it would take effect. Note that valueset composition (valueset containing valuesets) is not sufficient because it does not infer any structure, only membership. Note that in this context navigational groupers are not considered to be concepts - they don't have a CodeSystem identifier. SH: users would prefer to search than to navigate their way through a hierarchy to the item they want. "Picklists" can be considered distinct from ValueSets (adding priority and other properties). ML Usage in questionnaires. "The way to do this is in the expansion" DK Solution also available using Concept map translate given 'source' context, what likely values would be selected in a subsequent field. RH See also ValueSet Concept Order Extension. PWI "Tagging" may be preferred as it allows for multiple dimensions to be represented at the same time ML and also avoids codes appearing multiple times if they belong to more than one group. SH Would like to see standard for wider sharing of resources like reusable UI elements, and avoid overloading FHIR (separation of concerns). SS Much harder to add semantics to existing data, than it is to enforce the semantics at the point of data capture. TODO Elicit use cases from Rutt Lindström Condition vs Observation - care plan based on symptom. Other CodeSystems which reference SNOMED CT |
| 44 | General discussion on work being done in EU |
| 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 2023-09-19 ML CSCT now has official "Not for Profit" status as an entity. |
| 45 | IG Tooling Compatibility | 20 |
| 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
2023-08-22
2023-10-03 ML Ontoserver still a work in progress in this area. 2023-10-22 ML Ontoserver progressing to be trialed during NZ Connectathon in this context.
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| 46 | 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. 2023-10-22 AP <copy from 15:43> |
| 47 | Post R5 Concept Map - support for SNOMED Map features. |
| michael lawley Daniel Karlsson | 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 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 April 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. |
| 48 | Expand Alliance | 20 | 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 |
| 49 | Language behaviour compliance in Snowstorm | 10 | 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. |
| 50 | R5 changes suggested around specifying language using BCP-47 | 10 | 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 $expand operation Peter Williams This extra detail should be filled into FHIR-languages to avoid overloading/over complicating the HL7 page. 2022-08-31 ML CSIRO attempting to get R5 compliant Ontoserver ready in time for HL7 Connectathon. 2022-10-04 With this page moving to terminology.hl7.org it is no longer subject to the ballot process. Instead a "TSMG" ticket should be created. Daniel Karlsson and Rob Hausam will progress this. Rob Hausam Also tracking R5 changes to concept map - see http://build.fhir.org/valueset-concept-map-relationship.html. Peter Williams to check SI intention for R5 compliance. 2022-10-18 DK EHealth Working Group on Semantics - discussion on cross border infrastructure based on CDA. Suggestion that it could move to FHIR for new specifications/developments eg Lab Reports. 2022-11-02 RH Rob will check the status and how we can help it move 2023-02-07 RH R5 Ballot is complete. Deadline to complete resolutions is Feb 24th. Expectation to publish late April / early May. 2023-03-07: RH R5 going through QA currently. Some last-minute changes in ConceptMap: RH change in relationship types, new ValueSet to remove ambiguity. Directions of maps (very) explicit. No-map situation simplification. Element name changes. Choice datatypes in more places. ML property, dependsOn and product clarification. E.g. property is used in implicit ConceptMaps based on SNOMED complex maps. http://hl7.org/fhir/5.0.0-draft-final/conceptmap.html 2023-07-11 ML Added UP ticket - https://jira.hl7.org/browse/UP-436 (Unified Terminology Governance Project) |
| 51 | Language Reference Sets in FHIR |
| All | Mechanisms for working with Languages 24 August DK Added pull request to Snowstorm here Implementation by ML using existing fields and specifying LangRefset in displayLanguage parameter with "preferredForLanguage" code and wildcard Eg https://r4.ontoserver.csiro.au/fhir/ValueSet/$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 |
| 52 | 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. |
| 53 | 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
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
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 Glorytm) 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. |
| 54 | 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. |
| 55 | 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. 2024-03-13 RC Querying on patient data using below / isa - how is that negotiated between a data server and a terminology server (or do they need to be one and the same?) |
Potential Items for Discussion
Description |
| Owner | Notes & Actions |
|---|---|---|---|
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. This has now been implemented as text filters in ECL. Archive discussion. |
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 |
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 |
|
| |
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 | 15 | 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 | 10 | 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 | 10 |
| 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? |
Concluded Discussion
See also FHIR Terminology Services Discussions
Description |
| Owner | Notes & Actions |
|---|---|---|---|
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 | 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 | 10 | 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. |