20:00 UTC on Tuesday 23 June 2020 - 90 minutes.
- Bindings to FHIR Clinical Resources (e.g. value set bindings)
|Owner||Notes & Actions|
|1||Welcome and introductions||5|
Recording + Notes.
Summary of previous week (TS) and previous TB
FHIR DevDays - June 16-18, 2020 Cleveland, OH. Virtual Event
2020-06-23: Peter G. Williams presented introduction to SNOMED on FHIR, recordings to be posted.
HL7 Baltimore September 18 - 25 Fully Virtual. Connectathon 9 -11 Sept
SI Business + Expo October. Confirmed fully virtual.
|4||Interim Release of FHIR||5||Peter Jordan|
Proposed version "R4A", updates to Subscription, Medication Knowledge.
2020-06-23: Community is pushing against a new version. Likely won't happen.
|5||SNOMED on FHIR deliverables plan||10|
Discuss: Requirements for publishing - quality criteria, technical , maintenance plan needed before we commit to publish?
Investigate use of query Refset as a way to avoid coding ECL into Profiles. Could we detect a change in expansion membership. JR suggests mapping between FHIR XPath (identifying location in profile) and Query.
Option for "use at your own risk / best efforts for maintenance" / STU / Maturity Level (traditionally two named implementers are required). "Aim for best practice"
2020-06-23: Internal discussion to be held.
FSH-ized IG here: https://github.com/danka74/snomed-ig-fsh
Joint meeting between the two groups (TS & TB) discussing the IG at next weeks meeting (2020-06-30).
|6||COVID-19 known exposure||Topic requires a sponsor for group discussion|
|7||cocos.team (German)||Daniel Karlsson|
Update 26 May: Ian Green has been working with this Group and has brought requirements for SI COVID-19 back.
|8||Immune Status||Rob Hausam|
IPS received request on how to manage a statement of immunity to a disease (eg COVID-19)
See group chat discussion. In general, declaring Immunity is problematic. From a legal perspective as well as clinical ie you can say antibodies are present but whether or not that guarantees immunity is not obvious.
See list of concepts to be added to support declaration of immunity - however it was decided by working group to not proceed with this work at this time.
Archive next session.
A COVID-19 Guide is in development.
Use of Observation et al. resources for identifying laboratory, PoC and/or home tests plus combinations like patient specimen collection for lab test. A combination of Observation, Specimen, Device, and DeviceDefinition resources could meet such needs. Also, new Observation.code values will likely be created to allow this differentiation as well.
Linda has done a comparison of SI vs HL7 ValueSets see https://docs.google.com/spreadsheets/d/1P3DgnLOvr31H4cIfRa_cTfkdhBCC8acTzPCbHmjakrI/edit?usp=sharing
Snomed on FHIR Analysis: COVID-19 Symptoms Present
WHO Case Report form discussed with LogicaHealth. WHO Case Reporting form form contains finding context values (known present, known absence, unknown)
2020-04-28: German FHIR profiles here: http://cocos.team/profile.html
2020-05-12: Linda suggested discussing the Interoperability Alliance work next time. See http://www.snomed.org/news-and-events/articles/snomed-joins-covid19-interoperability-alliance
A generic SNOMED CT concept for "key worker" (or just "target population") is needed to state an immunization reason, or a reason for an immunization recommendation.
|11||Follow up on Blood Pressure.||10|
Is the "vital signs" scope too limited?
Distinction being made between "Vital Signs" blood pressure and general blood pressures.
No conclusion reached on "panel codes". Compromise to use whatever is recorded on the system and where none available use a high level concept.
Update 17 March: DK - NHS Limiting Scope, any update? Answer: No. Decided to transmit all blood pressures and other < 248326004 |Body measure (observable entity)| (blood pressure is not a body measure!), but only those that met the FHIR binding would have the LOINC code and relevant category.
DK Both FHIR and SNOMED have reasonably elaborate models for dealing with these which creates "interesting" opportunities for binding discussions.
Discussion on why Specimen (which - as an industry - has been around forever) is only at maturity level 2. Perhaps there's a lack of production implementations. DK: Specimen is a potential candidate for a SOF Published Profile.
The Implementation Guide is now building fine. Please everyone have a look and share comments. http://build.fhir.org/ig/IHTSDO/snomed-ig/index.html
|14||Cancer Disease Status|
Query about qualifier values used. Would it be better to use < 418138009 |Patient condition finding (finding)| ? (JR suggested immediate children ie "<!" rather than descendants)
See also 373117000 |Pathology examination findings indeterminate (finding)| (child of 250537006 |Histopathology finding (finding)|)
Update 31 March 2020 - PWI: links above no longer work. I was unable to find obvious alternative via http://hl7.org/fhir/us/mcode/
Options for Profile discussion:
Notes 26 Feb: UK working on pathology reporting - diagnostic / observation.
Suggestion that we try out two types of profile, both of which avoid issues of conflict between fields within the information model:
28 May: Plan to publish profile for the October conference (8 sessions + working between meetings. Completion for review Tues 14 October (or earlier since we'll need time to complete the IG?)
Tooling for profiles: Forge (.NET) is now R4
14 Jan 2020: Update from Rob on his progress with a new FHIR Template infrastructure. Required migrating/juggling what we had already built on older infrastructure. Sits under our implementation guide materials at build.fhir.org/ig/IHTSDO/snomed-ig/branches/new-template/ as Option 6: SNOMED Specific Profiles
Differential Table view shows the difference between the parent resource and our SNOMED-specific further profiling of it.
Discussion around practicalities of handling bindings where the ECL isn't very pretty, but the enumerated membership list could change very frequently e.g. a list of codes for vaccine preparations (or procedures) that are specifically relevant to some national childhood immunisation programme, and which can therefore change monthly as new vaccine preparations become available. Preferred implementation solution would be for suppliers to be able to consume ECL, however complex.
Discussion about what kind of separation should exist between the Implementation Guide (which should list things we think everybody should be doing in some certain way) and any more discursive musings that have have not reached that level of consensus or experience.
Thoughts on whether the IG should be balloted, and how to assess the maturity of any of it? Should each SNOMEDonFHIR published profile have its own (1-5) maturity metric stated?
RH: Suggestion that "published" valuesets would be read-only.
7 July 2020.