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Date/Time 

20:00 UTC on Tuesday 23 June 2020 - 90 minutes.

Objectives

  • Bindings to FHIR Clinical Resources (e.g. value set bindings)

Meeting Details

Onlinehttps://snomed.zoom.us/my/snomedhl7

Phone: See https://zoom.us/zoomconference for available phone numbers (meeting id 242-348-6949)

Chat: snomedIntl.slack.com #snomed-hl7-fhir


Discussion items

ItemDescription

Mins

OwnerNotes & Actions
1Welcome and introductions5

Recording + Notes.


2

Summary of previous week (TS) and previous TB

5
3Future meetings5

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.

4Interim Release of FHIR5Peter Jordan

Proposed version "R4A", updates to Subscription, Medication Knowledge.

2020-06-23: Community is pushing against a new version. Likely won't happen.

5SNOMED on FHIR deliverables plan10

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"

  • Peter G. Williams Discuss internally (FYI Jim Case Linda Bird Rory Davidson ), also with TS group. How are other non-computable artefacts maintained. Confluence gives us some publishing mechanism, as does FHIR. But the responsibility for this must be allocated - and accepted - for ongoing care.

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).

6COVID-19 known exposure

Topic requires a sponsor for group discussion
7cocos.team (German)
Daniel Karlsson

https://translate.google.co.uk/translate?sl=auto&tl=en&u=cocos.team%2Fterminologie.html

Update 26 May: Ian Green has been working with this Group and has brought requirements for SI COVID-19 back.

Valueset example: https://art-decor.org/art-decor/decor-valuesets--covid19f-?language=de-DE&id=1.2.276.0.76.11.466

8Immune Status
Rob Hausam

IPS received request on how to manage a statement of immunity to a disease (eg COVID-19)

http://build.fhir.org/ig/HL7/fhir-ips/branches/immune-status/ValueSet-condition-disease-immuneStatus-uv-ips.html

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.

9COVID-1935

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.

See cv19 , HL7 IG http://covid-19-ig.logicahealth.org , http://build.fhir.org/ig/HL7/fhir-saner/ , https://covid-19-ig.logicahealth.org/SignsSymptoms.html

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)

  • Rob Hausamto liase with the Saner project to determine remit - supply logistics, beds available etc. Group is generating an IG as output.

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


10Revisit Immunization5

Immunization

April 14:

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.

11Follow 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.

12Specimen30Riki Merrick

Specimen binding. Update from HL7 Specimen Project Group by Riki Merrick (and offer to review this group's work!)

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.

13Implementation Guide31

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

14Cancer Disease Status

Carmela Couderc


http://hl7.org/fhir/us/mcode/2019Sep/StructureDefinition-onco-core-CancerDiseaseStatus.html

http://hl7.org/fhir/us/mcode/2019Sep/ValueSet-obf-datatype-ConditionStatusTrendVS.html

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/

15Exemplar Profile

Publishing Profiles

  • Wrapped by implementation guide - in this case https://github.com/IHTSDO/snomed-ig
  • Value set publish to a live SI hosted Snowstorm instance. Alternatively Michael Lawley has offered to host.
  • Additional hosting on Simplifier (STU3, not yet R4 - January?)
  • Suggestion to review work already done to ensure R4 compatibility
  • Would value sets also be published as reference sets? Maintain via Refset tool and published in MLDS. Note: UK experienced substantial 'getting off the ground' effort in this area. Sweden have worked through ~10 (will request promotion of content to International Edition where appropriate).
  • HL7 FHIR Registry?
  • Option to have multiple profiles available at the same time using slicing.
  • Chance to do some technical work at HL7 San Antonio

Options for Profile discussion:

Specimen

Allergy Intolerance (DK)Condition
Medication distinct from previous work on MedicationRequest etc (PWI)Vital Signs (DK)Procedure (see also CarePlan (activity.detail.code) - KR)

Immunization

ImagingStudy

Observation Interpretation
CarePlan

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:

  1. Where we only use the code field for clinical content (plus the administrative fields)
  2. Where we restrict the code field to atomic values and all other resource fields should also be populated. Note that this does not solve the role group problem.

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?)

  • Build implementation guide
  • Setup FHIR server with relevant valusets

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?

  • Daniel Karlsson to try loading existing Allergy Intolerance profiles into Forge R4. The STU3 profiles loaded fine in Forge R4 as just STU3 profiles. There are almost no changes between STU3 and R4 for AllergyIntolerance, so by manually changing the XML files from "3.0.1" to "4.0.0" the files showed as R4 profiles with no errors displayed. Files uploaded to profile page.
  • Rob Hausam to take Observation questions to OO group, see Observation binding

RH: Suggestion that "published" valuesets would be read-only.

16Next meeting5


7 July 2020.


Meeting Files

  File Modified
PDF File FHIR FactSheet-Web-Final.pdf 2020-Jun-23 by Peter G. Williams