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Date 10:00 UTC on Wednesday 16 February 2022 - 90 minutes.   


  • FHIR Terminology Services and Resources discussion
  • FHIR Terminology Binding discussion

Discussion items



OwnerNotes & Actions
1Welcome and introductions2

Recording, notes & attendance.

2Previous Meetings2
3Round Table Introductions20ALL

India NRC - Manisha MantriSayali Pophalkar Gaurav Vaishnav Using SNOMED with LOINC and ICD-10.  FHIR recommended nationally as a standard.   Looking to build FHIR compliant TS at National Level, especially for lookup and validate & expand.

Australia - N/A

Belgium - Marie-Alexandra Lambot Anne Nerenhausen  multi-discipline data exchange programme for care-sets, FHIR objects codified in SNOMED CT (firstly allergy intollerance)

Estonia - Rutt Lindström switching to FHIR Nationally, preferring international terminologies.  No National TS yet, currently capturing requirements.

Hong Kong - Karissa Hung Maggie LauHave own terminology table, mapped to other terminologies including SNOMED CT.  Looking to learn more about using 

Netherlands - Pim Volkert Chantal Schitmeijer - using FHIR based terminology server which they supply to various vendors free to use except for usual licence fees - is an instance of Ontoserver, but not intended for use in "Live" system, instead used as offline supplier of terminology.  Attempting to lower barriers to adoption.   (Sander Mertens now working for a startup creating EHR system for GPs)

Norway - Oskar Hurtig using several Snowstorm servers in combination with SNOMED International's Managed Service.  Oskar's team in start-up phase looking at the introduction of SNOMED on FHIR for Norwegian customers.   Existing environment involves many classification systems (eg HealthTerm) which they're trying to consolidate with FHIR.  Developing own FHIR Resources.

New Zealand - Peter Jordan (HL7)  National Terminology Server for NZ currently under development.  Peter's own implementation "Terminz".   FHIR Release 5 underway eg changes to Concept Map.

Sweden - Daniel KarlssonNo clear decision made yet on using FHIR with SNOMED but there are a number of projects underway eg with HL7 Sweden.  Some competition in this space for Terminologies but 

United Kingdom - Andrew Perry(NHS) Various FHIR profiles in use for moving data between primary and secondary care incorporating SNOMED.   National Terminology Server procured (not publicly available - constrained by copyright eg non UK access).  Programme of implementations which use the National Server underway.  See

SNOMED International - Linda Bird Alejandro Lopez Osornio Kai Kewley Peter G. Williams

4Known FHIR Implementations /  National Terminology Servers10

FHIR ValueSet $expand Comparison Tool

National Terminology Servers: United Kingdom,  Netherlands, Norway


5Other Meetings10

Recent events:

HL7 Jan 2022 Virtual meeting: Aim for testing ConceptMap on the Connectathon (Jan 10-12).  590 attendees. Discussion on improving test suite (driven by need to create a group of trusted terminology servers for federation.  Also interest in IPS (International Patient Summary)).   Interest in LOINC, less so for ICD-11.    Another Australasia event hopefully planned for this year due to travel restrictions.

Upcoming events:

SI Business Meeting April 

Late April NZ / AU connectathon - still being planned.

HL7 May 2022 Dallas - virtual.  

HL7 September Baltimore, meeting and connectathon.

FIRELY Dev DaysNext will be US Edition in June 2022 (Cleveland, hybrid event)   (Dev days planned for once per year)

GDHP - Global Digital Health Partnership Jan 26 Mini Connectathon (IPS focus)   See Suzy Royfor information on SI, or  John D'Amore (ONC) at

6India specific situation and direction20
  • The overview of the usage of FHIR & other codes systems in India (For eg: SNOMED CT, LOINC, ICD) & overview of ‘Ayushman Bharat Digital Mission (ABDM)’   

FHIR Implementation Guide developed by India NRC.   Development Team also available - all options on the table.

PJ suggests high level architect to represent client and ask questions eg "how often does EHR have to validate a Terminology Server"   Some support in FHIR for server side caching (see $closure) on a per-client basis.  HL7 TX server needed extensive work around performance due to being used in IG Tooling.

  • The need for a terminology server supporting all the codes systems, country-specific extensions & refset, hosted for large users (or for the country)

16 Feb Particular interest in contributing to the development of ValueSets.

7SNOMED CT guidance around Allergy and Hypersensitivity


Asked group for review of FHIR specific elements in "

Implementation Guide for Use of SNOMED CT in Documentation of Allergy, Non-allergic Hypersensitivity and Intolerance" 

DK - suggests a dedicated meeting on this work.   Are there specific questions on this?  MAL - Too long to spend time in a meeting reading, would like feedback.

16 Feb DK Added examples to the FHIR IG, see   Rob H doing review prior to publication.

8Definition of GPS
Rob Hausam

Request that SI make the GPS ValueSet available as an extensional definition.

SI are (I think - PWI) in agreement to do this.

  • Peter G. Williamsticket and progress.   MAINT-1740 Target October 15 into production (need SearchAfter functionality for Refset Members).   Also check date for next GPS publication.

16 Nov Update:   "Search After" functionality will be available in Prod 1 Dec.

9Topics for Terminology Binding Stream

Best Links for Terminology Binding:

Resource bindings

Free SNOMED CT set for FHIR

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?   

19 Jan 2022 Example issue with 160444004 |Family history with explicit context pertaining to brother (situation)| using "Brother of subject" rather than "Brother" which - following that pattern - reduces the scope of family members compared to straight "relationship" eg "Brother" of which there are many more.  Do we need "Brother of Subject", but regardless what should be bound to? 

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

20 April:   Topic for discussion - new Resources introduced in R4B.    Also (Linn Brandt) Use case: Registries need nullFlavor-concepts in their value sets. Which code system to use?  Consider "Long COVID no longer present" as a topical example.  4 May DK: This is more of a negation issue than null flavour, also probability.   JL Distinction between unknown and uncertain.

Oct 5 Request for input from nutrition CRG.

10Language Reference Sets in FHIR

Mechanisms for working with Languages

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$expand?displayLanguage=*-x-sctlang-20581000-087109&_format=json&url=

Oct 5 Release of Ontoserver 6.5.0 which includes support for language reference sets as above.

16 Feb Some discussion about the proposal for making designation.use 0..* (previously 0..1) and also the introduction of additional use - looking for clarification.   R5 Ballot cut-off 22 Feb?

11SNOMED FHIR Implementation Guide

Implementation Guide for using SNOMED CT with FHIR.

IG Documentation:

Also look at the sample IG see build


  • Check build issues
  • Rerun with latest tooling (also sushi)
  • Run with local snowstorm provided as Tx
  • See Mark Kramer presentation 
  • CONTENT!  (PWI speak to PTB)
  • Merge in DUC branch (Designation Use Context) with a view to implementing in a branch of Snowstorm and making available via
  • Clean up other branches
  • Check templates are up to date - should now be self updating, see (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 and discuss further socializing.
  • TerminologyCapabilities caching is overly aggressive.

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*   (ie not specifying the version) or*/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.

13Long Term Home for Terminology Information

Rob Hausam (primarily Vocab WG)

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


7 Sept Relates to problematic page   PWI discuss internally - done.

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

14Any Other Business

Next time:   

Review of Terminology Binding for DiagnosticReport

MAL suggests discussing FHIR Resources for clinicians (clinical terminologists).

16 Feb MAL More of a question around teaching resources to bring clinical terminologists on board.   Existing information is vast, split between different websites and finding a step by step path through it is very difficult.   Something that could be taken forward by HL7 although there is an intersection with SNOMED CT when it comes to developing ValueSets.   PJ suggests contacting Director of Education Sadhana Alangar (US based) in HL7  re "FHIR for Clinicians" .  Crossover from OpenEHR may be useful.  

PJ suggests David Hays'   and  and asking questions on



OH Oskar looking at TS support for distribution of terminology resources.   Is there a comparison of server features somewhere?   This group have produced Features of Known Servers  PJ says Vocab Group are working on a set of minimal features are required for Terminology Servers (see CapabilityStatement resource)

MAL question for Rob Hausam as to whether someone has come up with Resources for capturing substance dependency PJ suggests Observation Resource also check out IPS IG   eg

Potential Items for Discussion

OwnerNotes & Actions

Concluded Discussion

See also FHIR Terminology Services Discussions

OwnerNotes & Actions

Meeting Files

  File Modified
Microsoft Word Document Allergy Guide v20220111.docx 2022-Feb-15 by Peter G. Williams
Microsoft Word Document ClinicalStatusValuesDiscussion_v1.1.docx 2022-Feb-15 by Peter G. Williams
PNG File image2021-11-30_20-18-16.png 2022-Feb-15 by Peter G. Williams

1 Comment

  1. I've asked HL7 International, and David Hay, about possible FHIR for Clinicians educations sessions, but in the meantime this  presentation from FHIR DevDays might be a good start for Marie-Alexandra Lambot and others.  The current HL7 International Education Catalogue for 2022 can be downloaded from here but doesn't contain anything directly aimed at clinicians or clinical informaticians.