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Date & Time

20:00 UTC Wednesday 6th July 2016

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  • To progress the SNOMED CT Template syntax

Agenda and Meeting Notes

Advanced Tables - Table Plus

Welcome, introductions and apologies

Linda Bird 
Agenda reviewLinda BirdReview agenda for today's meeting
Recap of last meetingLinda Bird

STEP 1 - Convert SNOMED CT Expression Template into FHIR Structure Definition (for use as Target of Mapping)


  • SNOMED CT Expression Template

[[ [1..1] @findingWithExplicitContext ]]:

#[1..2] @RGa { 246090004 |Associated finding| = ([[ [0..1] @associatedFinding ]]:

#[0..1] @RGb { 246112005 |Severity| = [[ [0..1] @severity]],

363698007 |Finding site| = [[ [0..1] @findingSite]] })

408732007 |Subject relationship context| = 410604004 |Subject of record|,

408731000 |Temporal context| = [[ [1..1] @temporalContext ]],

408729009 |Finding context| = [[ [1..1] @findingContext ]] }

  • FHIR Structure Definition

SCT_ConditionTemplate: SNOMEDCTExpressionTemplate

findingWithExplicitContext [1]: Coding

RGagroup [1..2]: RelationshipGroupElement

associatedFinding [1]: Coding

RGbgroup [0..1]: RelationshipGroupElement

severity [0..1]: Coding

findingSite [0..1]: Coding

subjectRelationship [1]: Coding410604004 |Subject of record|

temporalContext [1]: Coding

findingContext [1]: Coding

STEP 2 - Define Mapping Rules from Source Structure (FHIR Resource) to Target Structure (SNOMED CT Expression Template)


Condition: Resource

code [1]: CodeableConcept (coding [1..*] - system, version, code, display, userSelected [0..1] - text [0..1])

category [0..1]: CodeableConcept (values: complaint | symptom | finding | diagnosis)

clinicalStatus [0..1]: code (values: active | relapse | remission | resolved)

verificationStatus [1]: code (values: provisional | differential | confirmed | refuted | entered-in-error | unknown)

severity [0..1]: CodeableConcept

bodySite [0..1]: CodeableConcept


SCT_ConditionTemplate: SNOMEDCTExpressionTemplate

findingWithExplicitContext [1]: CodeableConcept

group [1..2]: RelationshipGroupElement

associatedFinding [1]: CodeableConcept

group [0..1]: RelationshipGroupElement

severity [0..1]: CodeableConcept

findingSite [0..1]: CodeableConcept

subjectRelationship [1]: CodeableConcept = 410604004 |Subject of record|

temporalContext [1]: CodeableConcept

findingContext [1]: CodeableConcept


rule_1: for  source.code as code where verificationStatus != "entered-in-error" then {

rule_1afor code where code in descendantOf (404684003 |Clinical finding|memberOf("") make target.findingWithExplicitContext = 413350009 |Finding with explicit context|, as rga groupA then {

rule_1aafor code make rga groupA.associatedFinding = code

rule_1abfor code where severity in descendantOf (272141005 | Severities|) OR findingSite in descendantOf (123037004 |Body structure|) make as rgb in memberOf("") OR findingSite in memberOf(" make as groupB then {

rule_1abafor source.severity as sev where severity in descendantOf (272141005 | Severities|memberOf("") make rgb groupB.severity = sev

rule_1abbfor source.bodySite as bs where findingSite in descendantOf (123037004 |Body structure|memberOf(" make rgb groupB.findingSite = bs }

rule_1acfor code make rga groupA.subjectRelationship = 410604004 |Subject of record|

rule_1adfor code make rga groupA.temporalContext = 410512000 |Current or specified time|

rule_1aefor source.clinicalStatus as cs, source.verificationStatus as vs  make rga groupA.findingContext as fc then {

rule_1aea: for vs make fc.coding as coding then {

rule_1aeaa: for vs make coding.

code = translate (


'status-to-findingContext-map', cs,





1aeb: for vs make


fc.system = ""



1aec: for vs make


fc.display = 

preferredTerm (en-us,

", 900000000000509007)


} }

  rule_1b: for code where code in descendantsOf (413350009 |Finding with explicit context| memberOf(" ") make target.findingWithExplicitContext = code then {


} }

Outstanding question - Q1Linda BirdDo we need to support naming of SNOMED CT Relationship Groups within the SNOMED CT Expression Template syntax? For example: [[ .... ]]: @RelationshipGroupName { .......}
  • Note: This requirement comes from the need for a stable name for each relationshipgroup, in the FHIR Structure Definition used to represent the SNOMED Expression Template that is the target of a mapping (examples above).
  • A possible alternative would be to not include relationship group names in the template, and instead rely on a reproducible approach to automatically generating these names (e.g. RG1, RG1.1, RG1.2, RG2, RG2.1). However, because these names are used in the mapping code, we would need to ensure that they are absolutely stable - so given this, is this approach appropriate?
Outstanding question - Q2Linda BirdWhat syntax should we use to define cardinality constraints?
  1. On a focus concept, an attribute or an attribute value - e.g. in the relevant slot [[ [1..*] < 123456 @slotName ]]
  2. On a relationship group - e.g. 123456 |concept|: #[1..*] { .......}
    • Note: The syntax must clearly indicate that the cardinality on a relationship group does not appear in the concrete expression that is generated when the expression template is populated. This is needed to distinguish an Expression Template (with relationship group cardinalities) from an Expression Constraint Template (for which the relationship group cardinalities do appear in the populated version of the template). In this example syntax, the "#" is being used to say "The following constraint needs to be removed when the template is populated."
Outstanding question - Q3Linda Bird

What is the expected behaviour when a cardinality constraint in an Expression Template is not met?

Outstanding question - Q4

Linda Bird

Are there any other template requirements that we haven't yet considered for other use cases (e.g. for concept authoring)

Confirm next meeting date/timeLinda BirdNext meeting to be held at 20:00 UTC on Wednesday 20th July

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