Peter G. Williams

Rob Hausam

Recording, notes & attendance.

Peter G. Williams

Rob Hausam

• 2021-01-12 - SNOMED on FHIR Meeting (TS)

Peter G. Williams

Recent events:

HL7 FHIR Connectathon Jan 13 - 15:  806 attendance, more focussed on education / high level SME discussions.  Less testing (compared to previous).  Designation Use Extension discussion (also via email) - on repeating the designation. 

Upcoming events:

SI April Business Meeting - Virtual.  19 - 22 April.  Proposed open door FHIR get-together for usual slot Tuesday 20 April.

FHIR Working Group May 24 - 28 + Connectathon  will be UK time based. 

FHIR Dev Days June 7 - 10 (Virtual)  March 1 deadline for presentation proposals.  FHIR Connectathon (GMT/ UTC) May 17, 2021 to May 19, 2021 - Virtual Event

Daniel Karlsson

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?

15 Dec DK Asking if the member forum are still keen to see engagement in this area - offer to help country implementations.   Difficult to make decisions on binding without a concrete use case.  ML We could look at / review IGs (DK As we did for COVID).

• Suzy Royplease work with Daniel and Nick E. to take forward something appropriate for next MF (will be in the New Year).

12 Jan Update: Contact planned with the MF - next call (Jan 22) is topic based, so after that one - 2 Feb (with Daniel)

Update on in-flight work in HL7 groups including "R4B" release.  See ongoing discussion.

Initial Balloting - January for Q2 publication.

R4B (R5 pushed further out) Initial ballot (for comment, scope confirmation) in May 2021.   Note Concept Map has dropped in maturity due to ongoing changes.  Further ballots September (Nov/Dec) with a view to publishing Q2 2022.

3 Nov 2020: Push to use terminology "properly" (eg correct URLs / URIs) linked to UTG tooling + process.  Still looking at changes for ConceptMap.

15 Dec 2020 Vocab Group Update R4B deadlines extended any items for ballot by the end of this week.   Plan to add additional concepts to ValueSet and keep working on extension (although not an official part of R4B).   What do we need to conclude to put the Designation Extension forward to be part of the core specification?

26 Jan 2021 Ballot sign-up starting Feb.  There must not be any breaking changes due to non-major-point release.

Implementations that parse out the Semantic Tag from an FSN and do something with it.   

Queries received by SI suggest that Tag being used to determine hierarchy, rather than purely to disabiguate.   Are SI having discussion internally about it?   Could it be exposed as a separate property in the FHIR API?   Translations make this interesting.  Sweden decided not to translate FSNs to avoid having two sources of truth.

If we proposed this as a property, what would be the data type, Code?   Note that extensions with additional tags would cause that CodeSystem to expand.   

• Michael Lawleyto raise a tracker for this proposal

Michael Lawley

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.

Peter G. Williams

Daniel Karlsson

Proposed example: http://localhost:8080/fhir/ValueSet/$expand?url=http://snomed.info/sct/45991000052106/version/UNVERSIONED?fhir_vs=isa/27624003&designation=sv

ML makes the case that unpublished content is not legitimate SNOMED and suggested using a not-SNOMED URI eg  http://snomed.info/xsct/45991000052106 in this case the code system would still be  http://snomed.info/xsct

Outstanding question: our pre-release (alpha + beta) packages do have a version as a future date in them, and continue to exist (although unpublished) even after the official release has shipped.

How would this look in a ValueSet expansion? Should we specify systemVersion or forceVersion in this case?

Update 2 June: LOINC have a similar issue with "Pre-release" identifiers - current release 2.6.7. Version 2.6.8PRE will contain the pre-release content. "To be useful they need to be considered part of the code system"

However in the case of SNOMED CT we would NOT condone unpublished identifiers being used in production systems. In the case of the COVID-19 concepts an interim release was done as an official release for 20200309. The use case here is for producers of SNOMED CT to reference concepts internally - as a work in progress.

11 Aug: Corrected the url listed above to the standard http://snomed.info/sct (not 'xsct'). Michael would still like to progress this. Needs further discussion in SNOMED Family of Languages group. Need for this is surfacing in Queensland Health.

10 Oct: follow up if Languages group went down the road of modifying the URI.   Also questions of composition where sibling packages are involved (eg both dependent, but separately, on the international edition).  Update - yes is on agenda.

12 Jan: This has (today) been implemented in snowstorm - xsct is preferred (PW says) because it has precedent in a way that "UNVERSIONED" does not, and (ML says) is more flexible because it can be used along with a version string. 

26 Jan URI formed with xsct now available in Snowstorm master branch.  Also implemented by Ontoserver.   Should we update the HL7 SNOMED page?   TODO Propose update to "Version" section of http://build.fhir.org/snomedct.html   eg strengthen "shoulds" to "shalls".

Mechanisms for working with Languages

Designation extension

Update 19 May: Suggestion that we work an example for SNOMED to discuss with Regenstrief (LOINC)

Update 2 June: Started worked example Designation Extension Example

Update 17 Nov:  Proposal to add more values into designation use https://jira.hl7.org/browse/UP-107

Update 1 Dec: Latest build: http://build.fhir.org/ig/IHTSDO/snomed-ig/branches/duc/StructureDefinition-designation-use-context.html   Ticket: https://jira.hl7.org/browse/UP-155 being replaced by https://jira.hl7.org/browse/FHIR-29821   ML suggested we need an additional value for 'Not Acceptable' that would need an additional value to be explicit, rather than relying on the absence of a 'row'.   Designation Use codeset, or the infrastructure codesystem?  See also http://build.fhir.org/languages.html##term

Update 15 Dec:  Discussing cardinality - when a designation can be applied to multiple roles, do we have repeated elements in a single extension block, or multiple extension blocks?  PJ Checking use case.    Use Case:  To allow tell the client what all use contexts (roles) are available so that it can a) select one making an informed choice and b) gradual degradation where the best available terms are used where they exist, falling back to a less preferable term where they do not.  Worked example from ML: https://gist.github.com/pgwilliams/8c742d68878b1fda0638a798668e42f2    also http://build.fhir.org/ig/IHTSDO/snomed-ig/branches/lawley-patch-1/CodeSystem-CodeSystemDesignationUseExample1.html 
On question if this should be part of core spec or remain in SNOMED IG we can consider if this is of use to any other Terminology eg LOINC or RxNorm.

12 Jan Update: Rob Hausam looking for clarity to take forward with Vocab group.   How to align this with other in-flight trackers (eg https://jira.hl7.org/browse/UP-107) that propose expanding designation use which - we think - seeks to overload designation use in a way that wouldn't ( ?) allow more than one value at the same time and these features of designations can vary independently.

12 Jan Proposal:   All 3 elements (including designation type) should be included in our proposed extension.   SNOMED implementations would then pick the most appropriate designation.use value from whatever set is offered in the spec   eg FSN where it is an FSN (because - although also considered 'preferred' - these are seldom used for user interfaces), PreferredForLanguage where we have the preferred term for a given language/dialect and Synonym for anything else.

26 Jan: RH update - is ongoing discussion.  Attempting "best of both worlds" approach.  Not on the Vocab group's agenda, won't be in R4B.    Question from ML about display vs preferredForLanguage here.  Proposed extension to list of designation use will necessitate repetition of designations where they have multiple uses.   See DK example here:  http://build.fhir.org/ig/IHTSDO/snomed-ig/branches/duc/ValueSet-DrugValueSetExample1.json.html

RH: Suggestion that Ontoserver and/or Snowstorm could try an implementation of our extension.   Clients are expected to ignore extensions that they don't understand.

Peter G. Williams

Implementation Guide for using SNOMED CT with FHIR.

Update 10 Dec: DK - main problem is URI/Ls which publisher has fixed ideas about. Publisher does not examine all folders - looks in profiles but not subfolders and doesn't seem to look in ValueSet folder.

Update 21 Jan: DK and RH have merged commits and these can be seen in the HL7 server build: http://build.fhir.org/ig/IHTSDO/snomed-ig/branches/new-template/ and build errors here: http://build.fhir.org/ig/IHTSDO/snomed-ig/branches/new-template/qa.html

Update 11 Feb: Grahame said that he'd show us how to set the URI so that it doesn't have to follow the base URI. Next person to try that can we fire a Zulip off to ask about it?

Update 16 June: DK wondered about moving everything to FSH (FHIR Short Hand) as it's so much easier to maintain. ML: Conversion available, but round trip problematic. DK page Re: snowstorm FHIR requirements, issues, etc.

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.

26 Jan

Next time:  

Peter Jordan

Michael Lawley

Impact of proposed changes (eg text searching in ECL) on FHIR. Questions around which language reference sets to use when there are multiple, especially partial/overriding context (referred to MAG for discussion)

8 Sept The FHIR specification does not specify a particular version of ECL, so we assume the latest.  Any enhancements added to ECL will be immediately relevant and available in FHIR.   Note that these latest additions while targeting descriptions are a concept filter, so display options (language etc) will affect the output of those concepts.   How about the filter parameter though, especially since ECL would allow multiple filters in multiple/different languages.

• Michael Lawley Suggested ticket: Parent and Child properties to (optionally?) support the Coding type.

Daniel Karlsson

Peter G. Williams

API for FHIR Resource to SNOMED Expression

• Daniel Karlsson Thought there might be some documentation from CIMI on this. Also notes from DMarkwell about constructor bindings.
• Peter G. Williams Pull these notes into confluence - can we mention it in the IG?

Peter G. Williams

Problems when dependencies do not align. Multiple code system resources represent multiple editions / versions.

ML: See code parameter to code system search. Should return code systems (ie versions) where that code is defined. International concepts would appear in every edition known to the server.

eg /CodeSystem?system=htp://snomed.info/sct&code=12345678&_elements=version

• Peter G. Williams Ticket implementing this lookup. Note that this could be implemented more generally for lookups of http://snomed.info/id/<SCTID> where the SCTID exists in an extension. Done - see STORM-262.

Peter G. Williams

CodeSystem "class vs instance" in url parameter between CodeSystem and ValueSet operations.

CodeSystem is understood.

In Valueset, url is the ValueSet url for example url = http://snomed.info/sct?fhir_vs= allows for the version URI to be used as stated in https://build.fhir.org/snomedct.html The base URL is either http://snomed.info/sct , or the URI for the edition version, in the format specified by SNOMED International in the SNOMED CT URI Specification.

The ValueSet version valueSetVersion is just some string identifier eg a timestamp or 0.1.0

Rob Hausam

What properties are returned?

Discussion: Both Ontoserver and Snowstorm are returning EffectiveTime which is not listed here (unlike other SNOMED specifics): https://build.fhir.org/snomedct.html

• Peter Jordan to raise a Jira ticket to ask for this to be returned - completed https://jira.hl7.org/browse/FHIR-26555

Point of interest: Grahame's server returns a copyright property.

Update 7 April - Question about whether this is required / desirable?

Michael Lawley

Terminology Capabilities: Default SNOMED Edition for a Server. Suggestion to invite Graham for a wider discussion. Resource is still at maturity 0.

11 August The resource is based on instances of code systems. Difficult to make statements about code systems generally, or specific SNOMED editions, etc. Will start a Zulip discussion on this. Michael Lawley Then potentially invite Grahame for a future discussion?

25 August It has been agreed that this resource will now have maturity level 1

See https://chat.fhir.org/#narrow/stream/179202-terminology/topic/tx.2Efhir.2Eorg.20New.20parameters.20for.20.24expand.20.26.20.24validate-code

8 Sept 20 Is there a Jira ticket ?   Rob says Grahame implemented this.

12 Jan:  RH update made to GG Server.   Documentation (assuming required) still outstanding.

Michael Lawley

Use case for fall back lookup when server does not know the answer to any particular question eg a façade server which has knowledge of all services it could potentially delegate to.

Aug 25: New capabilities in HAPI to allow delegation to an external terminology server.