Date 08:00 UTC on Sunday 3 April 2022 - 3Hrs 30mins.
Local time: 09:00-12:30 (Catered break: 10:30-11:00)
Objectives
- FHIR Terminology Services and Resources discussion
- FHIR Terminology Binding discussion
Meeting Details
Online: https://snomed.zoom.us/my/snomedhl7?pwd=UCtmRkdHZ3pVNDB1MnJuZmg2b3hUZz09
Chat: public-snomedintl.slack.com # snomed-hl7-fhir (ask for invite!)
Zulip Chat: https://chat.fhir.org/#narrow/stream/179202-terminology
Attendees
Peter G. Williams , Daniel Karlsson
Apologies
Meeting Recordings
https://drive.google.com/drive/folders/1u4BYDPVmcZr-lAN87Od8f2TgoahIq753?usp=sharing
Discussion items
Item | Description | Mins | Owner | Notes & Actions |
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1 | Welcome and introductions | 2 | Recording, notes & attendance. | |
2 | Previous Meetings | 2 | ||
3 | Other Meetings | 5 | HL7 May 2 - 4 (running in Eastern Time) 2022 Dev Days US Edition in 6 - 9 June 2022 (Cleveland / Hybrid) New HL7 Group TSMG (meeting Wed PM ET every other week) - Terminology Service Management Group (HTA Thursday AM is now a subgroup of the TSMG) 2022-02-22: Registration for April Business meetings open, as is call for abstracts for the SNOMED Expo fall 2022. HL7 17 - 23 September Baltimore European IPS meeting | |
4 | Round Table Introductions | 20 | ALL | 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. France - François Macary Phast 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 Feikje Hielkema-Raadsveld Ronald Cornet - 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 Karlsson, Anna Rossander No 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 Swiss Anna 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 https://digital.nhs.uk/services/terminology-servers United States Jeff PiersonIMO SNOMED International - Linda Bird Alejandro Lopez Osornio Kai Kewley Peter G. Williams |
5 | HL7 FHIR Update | Peter Jordan | FHIR Release Schedule : R5 will be trial use Q1 2023. New normative content will be added Q1 2026. Minimum capabilities https://jira.hl7.org/browse/FHIR-24698 (aimed at R5) | |
6 | ICD 10 Maps in FHIR | Issues:
Feikje Hielkema-Raadsveld suggested that the PJ: StructureMap, although not technically a 'terminology' resource and generally used for model mapping, is a possible solution for complex maps. | ||
7 | Recording suspected & negated diagnoses | JR: Current use case is: primary care physicians do not want to record the available code for "Long COVID" because (a) they may not have any proof that the patient ever had COVID, because they had it before testing was available and (b) even in those patients who tested positive for COVID there is no test to prove that their current chronic symptoms are caused by that. So the proposal is to give them a "Suspected Long COVID" code. MAL: Belgium use the confirmation code on the resource rather than a possible SNOMED CT code.
Historically, before the information models got around to adding their own support for contingent diagnoses, there have been codes for a small range of "suspected condition" only within the terminology. There are about 400 in SNOMED today. Of these, almost all are NEVER used in UK Primary Care. The significant exception is "Suspected urinary tract infection" plus a handful of others. Which also raises the question of whether clinicians really want, or should be allowed, to enter contingent diagnoses at all. In the case of the "Suspected Long COVID" code, for example, would it not be better to send what you know to be true e.g. "Post viral fatigue syndrome"? | ||
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11 | Allergy Resource Issues | |||
12 | Metadata in FHIR | |||
13 | NLP / Text Annotation | |||
14 | Terminology Binding - Diagnostic Report | Review by group, see DiagnosticReport AP: See here: https://developer.nhs.uk/apis/gpconnect-1-5-0/accessrecord_structured_development_DiagnosticReport.html TODO Work through the V2 VS http://build.fhir.org/valueset-diagnostic-service-sections.html for mapping and suggest additions to SNOMED CT where a mapping does not exist. | ||
15 | Known FHIR Implementations / National Terminology Servers | 10 | FHIR ValueSet $expand Comparison Tool National Terminology Servers: United Kingdom, Netherlands, Norway | |
16 | Other Meetings | 10 | 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 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 johnd@moreinformatics.com | |
17 | India specific situation and direction | 20 |
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 $closure) on a per-client basis. HL7 TX server needed extensive work around performance due to being used in IG Tooling.
16 Feb Particular interest in contributing to the development of ValueSets. | |
18 | SNOMED CT guidance around Allergy and Hypersensitivity | 20 | Asked group for review of FHIR specific elements in " Implementation Guide for Use of SNOMED CT in Documentation of Allergy, Non-allergic Hypersensitivity and Intolerance" DK - suggests a dedicated meeting on this work. Are there specific questions on this? MAL - Too long to spend time in a meeting reading, would like feedback. 16 Feb DK Added examples to the FHIR IG, see https://github.com/IHTSDO/snomed-ig Rob H doing review prior to publication. | |
19 | Definition of GPS | Rob Hausam | Request that SI make the GPS ValueSet available as an extensional definition. SI are (I think - PWI) in agreement to do this.
16 Nov Update: "Search After" functionality will be available in Prod 1 Dec. | |
20 | Language Reference Sets in FHIR | All | Mechanisms for working with Languages 24 August 2021 DK Added pull request to Snowstorm here Implementation by ML using existing fields and specifying LangRefset in displayLanguage parameter with "preferredForLanguage" code and wildcard Eg https://r4.ontoserver.csiro.au/fhir/ValueSet/$expand?displayLanguage=*-x-sctlang-20581000-087109&_format=json&url=http://snomed.info/sct/20611000087101?fhir_vs=ecl/160303001&includeDesignations=true 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 https://jira.hl7.org/browse/FHIR-36231 "Add designation context to designation.additionalUse" | |
21 | SNOMED FHIR Implementation Guide | Implementation Guide for using SNOMED CT with FHIR. 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/
TODOS
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22 | Any 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 sadhana@HL7.org (US based) in HL7 re "FHIR for Clinicians" . Crossover from OpenEHR may be useful.
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Potential Items for Discussion
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Concluded Discussion
See also FHIR Terminology Services Discussions
Description | Owner | Notes & Actions | |
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Meeting Files