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Date 10:00 UTC on Wednesday 16 March 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.

16 March: This past month is that we’ve done some internal training on FHIR to prepare our team and (softly) requested our leaders to help us create a national recommendation on the use of SNOMED on FHIR in Norway. The use of FHIR and SNOMEDCT are separate recommendations already. We’ve also identified a use case where we would like to create some VitalSign profiles with terminology bindings to SNOMEDCT and be able to locate test patient data using a SNOMEDCT code search. This is primarily a way to learn terminology bindings and ask better questions to this forum, as well as to some extent understand our terminology server needs.

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

4Terminology Binding - Diagnostic Report

Review by group, see DiagnosticReport

AP: See here:

TODO Work through the V2 VS for mapping and suggest additions to SNOMED CT where a mapping does not exist.

5Known FHIR Implementations /  National Terminology Servers10

FHIR ValueSet $expand Comparison Tool

National Terminology Servers: United Kingdom,  Netherlands, Norway


6Other 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  meeting and connectathon.

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

7India 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.

8SNOMED 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.

9Definition 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.

10Language Reference Sets in FHIR

Mechanisms for working with Languages

Designation extension

24 August 2021 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?

16 Mar See Tuesday meeting cardinality discussion 2022-03-08 - SNOMED on FHIR Meeting (TS & TB) and Tracker "Add designation context to designation.additionalUse"

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.
12Any Other Business

Next time:   

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.  

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-Mar-15 by Peter G. Williams
Microsoft Word Document ClinicalStatusValuesDiscussion_v1.1.docx 2022-Mar-15 by Peter G. Williams
PNG File image2021-11-30_20-18-16.png 2022-Mar-15 by Peter G. Williams