Page History

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.

56

Post R5 Concept Map - support for SNOMED Map features.

Alejandro Lopez Osornio Marie-Alexandra Lambot

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

67

Allergy IG Demonstrator

20

https://ihtsdo.github.io/sct-implementation-demonstrator/

To be shared at the next Allergies CRG (late May)

78

Expand Alliance

20

XPA - 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.

98

Testing Frameworks

20

Testing Frameworks. Background: IG Tooling using servers other than tx.fhir.org servers may need to implement additional parameters that are outside of the core specification. GG has put together a test suite to confirm alignment to meet IG Tooling needs. Command line flag to the validator to run these checks.

Issues encountered - some expected responses include nesting (Ontoserver's response does not do this). Syntax for regexs may be non-standard flavour. Examples show only translation display elements - "use" is not populated. Tx Server limited to 1000 codes in expansion so test suite is expecting to see errors for large CodeSystem whereas Ontoserver would not expect to return an error.

910

Jamaica update

Working with OpenEHR and FHIR

1011

Agenda for April Business Meeting

Peter G. Williams

National Implementation - how best to manage ValueSets (Rutt Lindström )
- should be a one-off exercise
- static substrate, or generate documentation around changes.
Allergy Guide - crossing SNOMED and FHIR (See Jane Millar for template)
Demo of Post Coordination
Snowstorm support for additional codesystems
Marie-Alexandra Lambot resource visualisation work

1112

Visualisation of FHIR resources

10

MAL working on visualisation of FHIR resources - entity relationship diagram.

View file

name	medicationLine20230315.pdf
height	250

2023-03-21 AP Shared:

1213

European Terminology Services Collaboration

10

Rutt Lindström

There is a European Commission working group under MyHealth@EU that is considering requirements for future terminology services for EU cross border eHealth services (ePrescription, eDispensation, Patient Summary, etc).
A temporary side activity of this group is to discuss national terminology server and terminology management systems implementations. Most people involved in the group are also involved in the national terminology services projects, and sharing those plans and experiences are helpful for finding the middle ground and needs for common EU services.

Rutt Lindström is the co-lead of that group. If you're interested in learning more, or you're just bored with your life and feel like chatting with someone about these topics, please get in touch.

1314

Allergy Guide work

5

Allergy Guide binding question on representing symptoms - discuss on next Tuesday call.

MAL - has finished current version of guide. Some layout work to do and small additions possible prior to publishing.

1415

Resource consistency

10

Looking to engage with various HL7 Work groups to flag up inconsistency of various elements between resources. There is hopefully an opportunity to address this as we start talking about FHIR 6.0

1516

CDS Hooks

10

HL7 CDS Hooks appears to have 2 specification releases. Is version 1 the main release in use.

https://cds-hooks.org/ (Clinical Decision Support workgroup own this - Bryn Rhodes)

CQL may have more traction.

2023-03-07: Demonstrator developed https://github.com/IHTSDO/snomed-fhir-cds-service

1617

Clinical Impression Questions

30

_https://docs.google.com/document/d/1KwhQDbQ6lcOl8JukuCp-lXWGJE2aYxqJ/edit

RH: R5 will be entirely trial use. Nothing will be made normative in there. PJ: R6 (2026?) will attempt to move as many resources as possible to be normative. RH This resource does not have clear consensus around what it is to be used for. RH assumes "Subjective, Objective, Assessment and Plan (SOAP)" - expected to be a single physician performing

ClinicalIImpression.Performer has 0..1 cardinality. What happens if a team is involved? Options: cardinality could be changed, team leader could be recorded, single practitioner object could be used to represent a team.
ClinicalImpression.problem what does "relevant" mean in this element? RH Took this to mean relevant to this particular encounter. ML Would be up to the clinician to decide what is relevant to a particular encounter. MAL: How do we indicate a grouping of potential diagnoses to be a differential set?
ClinicalImpression.investigation is this only history and examination. This 0..* element was removed between R4 and R5. RH Thought that it wasn't sufficiently distinct from the other fields. RH Recommends that MAL have a discussion with the Patient Care Working Group to explore why these decisions were made.
Apparently inconsistency between resources which sometimes use two separate start / end dates and sometimes use a period object. RH Agrees that working towards consistency is desirable.
ImmunizationRecommendation. Why was the request resource pulled out specifically when a generic request object could be used? RH Public Health WorkGroup made this decision, notes that immunization is distinct from medication because a condition is not necessarily. PJ suggests that these questions be raised in Zulip ( https://chat.fhir.org/ ) and in specific workgroup discussions.

Contacting HL7 Working Groups (Use co-chairs as points of contact)

2023-02-07 Looking for diagrams showing relationships between resources, in particular workflows.

RH suggests: ClinFHIR: http://clinfhir.com/ Graph Builder 2 tool: http://gb2.clinfhir.com/

1718

Allergy Guide Examples

Patients with multiple symptoms - is not obvious how to do this in FHIR. The condition resource does not lend itself to symptoms. There are examples of using the Observation Resource, but seems "sketchy"

Both Condition and Observation Resource have ways of recording who is making the observation (see "performer").

PJ - This should be attached to an Encounter. See http://build.fhir.org/encounter.html which has a 0..* Reason which takes a http://build.fhir.org/valueset-encounter-reason.html

RH "Presenting Complaint in the patient's own words" DK before there is an Encounter, there is a Service Request http://build.fhir.org/servicerequest.html (in R4 has reasonCode and reasonReference, but in R5 there is just a reason which is a CodeableReference)

2023-03-07: Corrections to the Allergy Guide made, proof reading in progress, Target publication before business meeting in April 2023.

1819

R5 changes suggested around specifying language using BCP-47

10

Rob Hausam

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 G. 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 G. 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

1920

MRCM in FHIR

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

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 G. 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.

2021

Support for other CodeSystems in Snowstorm.

Confirmation that SI will be adding some support for other CodeSystems based on leveraging the existing HAPI library support for such things. Will be limited to the FHIR API (not the "native" Snowstorm API, except perhaps augmenting our return for ICD-10 maps to include the term associated with the code). This Will allow us to host the UK Extension due to the requirements of their extensive maps.

Targeting August release of Snowstorm. Plan is to contribute code back where enhancement is required.

2022-08-23 See https://github.com/IHTSDO/snowstorm/releases/tag/8.0.0-beta (in use by India)

2022-10-18 PWI Pull request for this work to be merged into MAIN Snowstorm, priority of this under discussion.

2023-02-07 Just waiting for test plan completion before merge can be progressed.

2023-02-21 This work now merged from Snowstorm-X into the "develop" branch of Snowstorm Prime.

2122

Upcoming R5 changes

Rob Hausam

2022-8-23 RH R5 Deadline now September 4

Rob Hausam please create relevant tracker to take forward the additions marked green in this page: Changes for R5 2022-10-04 See above re DK + RH taking this forward.
Peter G. Williams merge this agenda item with similar one above.

2022-11-1 RB: Publication is expected after February 2023.

2023-02-21 PJ Reconcilliation to be completed by next week.

2223

Topics for Terminology Binding Stream

Jeremy Rogers

Collecting topics for TB stream here, with a view to having a call when there's sufficient material

FamilyMemberHistory - how is "no family history of X" best represented?

FreshDesk ticket question on Allergy substance cross field validation. DK: Mappings to other information models, is that helpful?

Oct 5 2021 Request for input from nutrition CRG.

8 Feb 2022 MAL Patient Care group proposing the use of an extension (specified by Daniel) to represent Allergy Type to add non-allergic hypersensitivity. MAL wondered about allowing a Codeable Concept there rather than a Code to allow for greater expressivity. Resource not planning on being Norminative in R5.

2022-11-1 DK: Immunizations may be a good candidate for future discussion MAL: can present advances. DK: Also, Specimen SNOMED vs Specimen resource.

2324

Publishing SNOMED codes in IGs and licencing conditions.

Mechanisms for working with Languages

Licensing issues for IGs referring to SNOMED codes. Is this written down anywhere with some sort of rigour?

Consider the licence statement that is presented when accessing the browser. Should something similar be mandated for inclusion in any document published? What if a patient's medical record were to be published?

Peter G. Williams find clarity here - email discussion started with Suzy Royand Jane Millar

Update 12 Jan - "One Page Policy" to be discussed internally. HL7 agreement indicates other parties would require affiliate licence unless they restricted their usage to the Global Patient Set.

26 Jan Question from PJ about inclusion of COVID Vaccine concepts in the GPS (advised that it is only released yearly) FYI Rory Davidson See also MF discussion here. SuzyR will follow up. See also early preview page.

06 April: SR covid vaccines have been/will be incorporated into July release. They will be in GPS when ready.

8 Feb 2022 This was discussed at a CSRM meeting - Peter G. Williamsfollow up with Suzy Roy . DK Also do we specify boilerplate copyright statement? This should also be specified in our IG (or referenced).

2022-04-19 Beta release of the IPS sub-ontology (which will include relationships but not axioms) see https://www.snomed.org/snomed-ct/Other-SNOMED-products/sub-ontology-international-patient-summary due for Tues 3 May. ML concerned that having the codes in a different CodeSystem breaks interoperability - further discussion required on this point internally Kai Kewley Alejandro Lopez Osornio Suzy Roy

2022-11-1 RB: For the IPS Guide the copyright messages were reviewed, and approved by Suzy:

Possible valid copyright statements used in IPS Implementation Guide, select and adapt the appropriate one depending on the content:

The SNOMED International IPS Terminology is distributed by International Health Terminology Standards Development Organisation, trading as SNOMED International, and is subject the terms of the Creative Commons Attribution 4.0 International Public License. For more information, see SNOMED IPS Terminology
The HL7 International IPS implementation guides incorporate SNOMED CT®, used by permission of the International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED CT was originally created by the College of American Pathologists. SNOMED CT is a registered trademark of the International Health Terminology Standards Development Organisation, all rights reserved. Implementers of SNOMED CT should review usage terms or directly contact SNOMED International: info@snomed.org
This value set includes content from SNOMED CT, which is copyright © 2002+ International Health Terminology Standards Development Organisation (IHTSDO), and distributed by agreement between IHTSDO and HL7. Implementer use of SNOMED CT is not covered by this agreement

2425

Language Reference Sets in FHIR

All

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 G. 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

2526

SNOMED FHIR Implementation Guide

Peter G. 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 G. 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 G. Williams contact Ole Vage & Feijke re Translation Group and contributing to IG relating to use of languages in FHIR.

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 )

Looked at http://build.fhir.org/snomedct-usage.html and the animal breeds http://build.fhir.org/valueset-animal-breeds.html which is extensionally defined with a complete set of animal breeds, most of which were inactivated in the International Edition in 20210731 and reactivated in the Veterinary Extension.

Peter G. Williams raise tickets for the usefulness of the usage page and also for the animal breeds that if they referenced the Veterinary Extension then the concepts would be active there, and a an ECL or ISA definition could be used in the ValueSet https://vtsl.vetmed.vt.edu/extension/

2023-02-07 MAL work for Allergy Implementation Guide (which the SNOMED IG will link to) see SNOMED CT 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)).

2627

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 G. 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.

2728

Long Term Home for Terminology Information

Rob Hausam (primarily Vocab WG)

Long Term Home for Terminology Information that can be maintained independently of FHIR versions.

See https://chat.fhir.org/#narrow/stream/179202-terminology/topic/Why.20does.20the.20spec.20contain.20a.20SNOMED.20CodeSystem.20resource.3F

7 Sept Relates to problematic page https://www.hl7.org/fhir/r4/codesystem-snomedct.html PWI discuss internally - done.

Update 21 September 2021 - General agreement that that page can be removed. Is out of date and not serving useful purpose.

Update 25 Jan 2022 - HL7 intend to make The THO https://terminology.hl7.org/ a home for all terminologies and valuesets.

Next Time: Move to archived discussion, make note in IG

2023-03-07: RH Vocab WG has a new name: Terminology infrastructure WG

2829

IPS / GPS progress

Suzy Roy

Alejandro Lopez Osornio

IPS Terminology Subontology - beta went out 2 weeks ago, now in feedback until June 30. Publication for the end of the year. ML expressed issues around not being conformant to RF2 spec but is missing module dependency file. ModuleId is present but invented Concept. ALO/SR suggested ML give that as feedback.

GPS expected towards the end of September. Currently working with contributing organisations, which will then go to internal authoring. ALO GPS may turn out to be less useful and focus could be on IPS in future.

2022-10-18 See https://gps.snomed.org/ also available in MLDS, published 2021-09-30, based on INT 20210731 PWI will follow up for 2022's copy. SR IPS targeting Nov 30 2022. Sub-ontology steering committee (internal) meeting next week.

2022-11-1: RB ML have received a new beta version and are testing. ML: The effective time in MDRS may be pointing to July instead of November. No MRCM content, it is required fur the type of the concrete domain attributes.

2023-03-07: IPS has a new management process. Feedback received will be managed by the most appropriate SDO.

2930

Snowstorm post-coordination updates