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

Previous Meetings

2

@Peter Williams

@Rob Hausam

• 2026-04-07 - SNOMED on FHIR Meeting

• 2026-03-18 - SNOMED on FHIR Meeting

• 2026-03-03 - SNOMED on FHIR Meeting

Atlassian Migration

5

@Peter Williams

New Confluence Space:  SNOMED on FHIR

Discussion moved to forums: https://forums.snomed.org/c/groups/snomed-fhir/40

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

Update on collaboration

20

@Suzy Roy

https://docs.google.com/presentation/d/1SBAmfCNSdOP6u6ZS9xPxbKDR-GjtO5HWEiOWRO-2xqI/edit?slide=id.p2#slide=id.p2

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.

ECL Core

@Kai Kewley

Cut down specification of ECL for reasonable implementation https://docs.google.com/presentation/d/1gxN6htJh86L11zGlDCfERDc8iqmnXVz-bum3CUon5m4/edit?usp=sharing

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/

Federated Distribution

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.

Effective Time

@Peter Williams

@Kai Kewley

@michael lawley

Peter Jordan

Continued from 2026-04-07 , also earlier discussion page https://conf.spaces.snomed.org/wiki/spaces/FHIR/pages/133154695

Rendering Effective Time in FHIR $lookup operation. See https://chat.fhir.org/#narrow/channel/179244-snomed/topic/Correct.20Data.20Type.20of.20effectiveTime.20Property/with/583176096 Note that the HL7 SNOMED page declares this has type dateTime : https://terminology.hl7.org/en/SNOMEDCT.html#snomed-ct-properties

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.

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

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

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

 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

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

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.

Tx Ecosystem

@Daniel Karlsson 

ML Owner of extension gets to say what the authoritative source for that extension is.

https://tx.fhir.org/tx-reg/

Registration (after proving conformance) is done via a json file - pull request to a GitHub repository

Snowstorm FHIR API Workplan 

@Peter Williams 

@Kai Kewley 

The following Snowstorm FHIR API work is planned for May/June

• Upgrade to HAPI 8.0

• Fix caching of Terminology Capability Statement

• Enhance API to pass tests needed to be used as authoritative source for HL7 IG Tooling

• Documentation & Postman coverage (check we're pointing to the correct repo)

• Exposing LOINC id when working in LOINC Ontology Extension 

• Implicit Concept Map - support for default maps between CodeSystems where an Alternate Identifier file exists

• Support for ECL 2.2 feature that adds support for alternate identifiers

• R5 (not had any requests here, does any user have specific feature requests?).   Consider options for adding eg Map advice in R4 as a compromise or in any event. 

@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.

https://github.com/IHTSDO/snowstorm-x

Concept Maps

All

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 

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.

Magic Codes Zulip Discussion

@Peter Williams 

@Daniel Karlsson 

@Rob Hausam 

Magic Codes and Observable Entities as Questions and Clinical Findings as Answers

https://chat.fhir.org/#narrow/channel/179166-implementers/topic/SNOMED.20Magic.20Codes.20.28RESTful.20API.20Observation.20Queries.29

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

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.

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' 

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

HL7 and OpenEHR

@Maryam Razavi 

@Alejandro Lopez Osornio 

https://www.pulseit.news/australian-digital-health/hl7-and-openehr-considering-closer-ties-and-standards-alignment/

https://www.youtube.com/watch?v=qbq-kuWyTcg

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.

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

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”

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

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.

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:

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.