10:00 UTC on Wednesday 30 August 2023 - 1Hr
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
Staff
Peter G. Williams Alejandro Lopez Osornio
Apologies
Meeting Recordings
https://drive.google.com/drive/folders/1u4BYDPVmcZr-lAN87Od8f2TgoahIq753?usp=sharing
Discussion items
Item | Description | Mins | Owner | Notes & Actions |
---|---|---|---|---|
1 | Welcome and introductions | 2 | Recording, notes & attendance. Check questions in Zulip and SNOMED International #snomed-hl7-fhir | |
2 | Previous Meetings | 2 | ||
3 | Other Meetings | 10 | Recent events: Upcoming events: HL7 September (Phoenix, AZ) 9 - 10 Connectathon, followed by 5 days working groups. FHIR North (Canada) Oct 17 - 18 https://fhirnorth.mohawkcollege.ca/ SNOMED International Atlanta, GA 22 - 27 October. FHIR Meeting on Sunday 22 Oct. HL7 Australia 20 - 21 November Melbourne FHIR Connectathon HL7 Netherlands November 9 - 10 HL7 New Zealand and Australia: 28th of November, in Hamilton NZ. Joint FHIR connectathon centered around the IPS use case. Backed by HealthNZ. Other Regular Meetings: HL7 Group TSMG (meeting Wed PM ET every other week) - Terminology Service Management Group (HTA Thursday AM is now a subgroup of the TSMG). 2022-05-17 RH Joint session with Vocab at last business meeting. 2022-06-14 Group has approved minimum capabilities for terminology servers. Now looking at bigger/better HL7 Terminology Server | |
4 | Observables Model | Discussion on grouping. AP advertised 'exclusion refsets' which identify groupers, including descendant count and textual matches. | ||
5 | IG Tooling Compatibility | 20 | Requirements for making a Terminology Server compatible with IG Tooling See Zulip discussion here: https://chat.fhir.org/#narrow/stream/179202-terminology/topic/Terminology.20server.20requirements.20for.20IG.20builds.2E.2E.2E 2023 2023-07-25
| |
6 | Observables model | Question on the Observables Model (- was discussed in both the MAG and the EAG. Yongsheng Gao currently looking at proposals and next discussion will be at all staff meeting in June. | ||
7 | Post R5 Concept Map - support for SNOMED Map features. | Concept maps and SNOMED Maps - how to materialize as both R4 and R5. Metadata needed: target CodeSystem URI, source and target ValueSets. Do we assume that a simple map is an equivalence. For complex maps, how are the additional fields represented? Eg in property, dependsOn and product (these are typed). See 5.2.3.3 Complex and Extended Map from SNOMED CT Reference Sets CC Kai Kewley Update 2023-06-13 Now working in confluence Concept Map in R5 2023-07-11 Work being done (ML) around clarity and specification for the parameters used in implicit Concept Maps. 2023-07-25 Michael Lawley and Dion had a discussion on metadata and put together a proposal of a JSON based metadata, presumably to be presented to the MAG | ||
8 | Allergy IG Demonstrator | 20 | https://ihtsdo.github.io/sct-implementation-demonstrator/ To be shared at the next Allergies CRG (late May) 2023-07-25 Alejandro Lopez Osornio a new version available, resolving Marie-Alexandra Lambot feedback The guide is published in: SNOMED CT Implementation Guide for Allergy, Hypersensitivity and Intolerance (Alejandro Lopez Osornio to review sync with WIP version, link from the guide to the demo tool) | |
9 | Expand Alliance | 20 | XPA - Expand Alliance European Project. Interoperability in Europe, targeting providing 6 x 40 hours of medical interoperability training to 40 students to fill gaps in existing offerings. HL7 Europe (consisting of all HL7 European country affiliates) also participating. 2023-05-30 Submission made (SNOMED International is a co-partner). Response expected by the end of the Summer. | |
10 | Testing Frameworks | 20 | Testing Frameworks. Background: IG Tooling using servers other than tx.fhir.org servers may need to implement additional parameters that are outside of the core specification. GG has put together a test suite to confirm alignment to meet IG Tooling needs. Command line flag to the validator to run these checks. Issues encountered - some expected responses include nesting (Ontoserver's response does not do this). Syntax for regexs may be non-standard flavour. Examples show only translation display elements - "use" is not populated. Tx Server limited to 1000 codes in expansion so test suite is expecting to see errors for large CodeSystem whereas Ontoserver would not expect to return an error. Now related to #4 IG Tooling compatibility. | |
11 | Jamaica update | New SNOMED member. Working with OpenEHR and FHIR. Onboarding is ongoing. No detailed use cases are recorded yet. | ||
12 | Agenda for April Business Meeting |
| ||
13 | Visualisation of FHIR resources | 10 | MAL working on visualisation of FHIR resources - entity relationship diagram. 2023-03-21 AP Shared:
2023-07-25: interesting tools: | |
14 | New page for eHealth Standards Belgium | 10 | https://www.ehealth.fgov.be/standards/fhir/ PJ suggests looking into: http://hl7.org/fhir/R5/clinicalusedefinition.html Based on the NZ medication interoperability experience. Challenges of sharing codes. | |
15 | European Terminology Services Collaboration | 10 | Rutt Lindström | There is a European Commission working group under MyHealth@EU that is considering requirements for future terminology services for EU cross border eHealth services (ePrescription, eDispensation, Patient Summary, etc). Rutt Lindström is the co-lead of that group. If you're interested in learning more, or you're just bored with your life and feel like chatting with someone about these topics, please get in touch. |
16 | HL7 Europe Laboratory Implementation Guide | 15 | See https://github.com/hl7-eu/laboratory for context. Language issues inside Codings - a way of putting a language tag inside a Coding? DK: In cross border situation, question is where the translation should happen (eg keep the original pre-translated terms present along with the translation). ML: Normally the display text in the coding is in the language of the Resource itself. There is a generic extension for anything String typed that would allow its language to be specified. See https://hl7.org/fhir/extensions/StructureDefinition-translation.html | |
17 | Language behaviour compliance in Snowstorm | 10 | BCP-47 requires a dash every 8 digits so SCTIDs need to be broken up to be compliant. Also the "x-sctlang" is required. Also discussed GG's request to Kai Kewley in the behaviour around language headers and how they interact with the displayLanguage in the HTTP GET request. | |
18 | Allergy Guide work | 5 | Allergy Guide binding question on representing symptoms - discuss on next Tuesday call. MAL - has finished current version of guide. Some layout work to do and small additions possible prior to publishing. | |
19 | Resource consistency | 10 | Looking to engage with various HL7 Work groups to flag up inconsistency of various elements between resources. There is hopefully an opportunity to address this as we start talking about FHIR 6.0 | |
20 | CDS Hooks | 10 | HL7 CDS Hooks appears to have 2 specification releases. Is version 1 the main release in use. https://cds-hooks.org/ (Clinical Decision Support workgroup own this - Bryn Rhodes) CQL may have more traction. 2023-03-07: Demonstrator developed https://github.com/IHTSDO/snomed-fhir-cds-service | |
21 | Clinical Impression Questions | 30 | _https://docs.google.com/document/d/1KwhQDbQ6lcOl8JukuCp-lXWGJE2aYxqJ/edit RH: R5 will be entirely trial use. Nothing will be made normative in there. PJ: R6 (2026?) will attempt to move as many resources as possible to be normative. RH This resource does not have clear consensus around what it is to be used for. RH assumes "Subjective, Objective, Assessment and Plan (SOAP)" - expected to be a single physician performing
Contacting HL7 Working Groups (Use co-chairs as points of contact) 2023-02-07 Looking for diagrams showing relationships between resources, in particular workflows. RH suggests: ClinFHIR: http://clinfhir.com/ Graph Builder 2 tool: http://gb2.clinfhir.com/ | |
22 | Allergy Guide Examples | Patients with multiple symptoms - is not obvious how to do this in FHIR. The condition resource does not lend itself to symptoms. There are examples of using the Observation Resource, but seems "sketchy" Both Condition and Observation Resource have ways of recording who is making the observation (see "performer"). PJ - This should be attached to an Encounter. See http://build.fhir.org/encounter.html which has a 0..* Reason which takes a http://build.fhir.org/valueset-encounter-reason.html RH "Presenting Complaint in the patient's own words" DK before there is an Encounter, there is a Service Request http://build.fhir.org/servicerequest.html (in R4 has reasonCode and reasonReference, but in R5 there is just a reason which is a CodeableReference) 2023-03-07: Corrections to the Allergy Guide made, proof reading in progress, Target publication before business meeting in April 2023. | ||
23 | R5 changes suggested around specifying language using BCP-47 | 10 | See Tuesday meeting item #6 Changes for R5 and check on use of dialect in x form in ECL Specification Appendix C: Appendix C - Dialect Aliases Note that where a language reference set pulls from more than one language, the BCP-47 tag could potentially missing out the <lang> element and start directly with "x-". Options for referring to multiple languages: could be done either with a * (see https://developer.mozilla.org/en-US/docs/Web/HTTP/Headers/Accept-Language#syntax ) or with a comma separated list to indicate a priority order (although this isn't supported by the FHIR parameter (unless the server went out of it's way to allow for this), or use the accept-language header). Use case is in the displayLanguage input parameter to a ValueSet $expand operation
2022-08-31 ML CSIRO attempting to get R5 compliant Ontoserver ready in time for HL7 Connectathon. 2022-10-04 With this page moving to terminology.hl7.org it is no longer subject to the ballot process. Instead a "TSMG" ticket should be created. Daniel Karlsson and Rob Hausam will progress this. Also tracking R5 changes to concept map - see http://build.fhir.org/valueset-concept-map-relationship.html. Peter G. Williams to check SI intention for R5 compliance. 2022-10-18 DK EHealth Working Group on Semantics - discussion on cross border infrastructure based on CDA. Suggestion that it could move to FHIR for new specifications/developments eg Lab Reports. 2022-11-02 RH Rob will check the status and how we can help it move 2023-02-07 RH R5 Ballot is complete. Deadline to complete resolutions is Feb 24th. Expectation to publish late April / early May. 2023-03-07: RH R5 going through QA currently. Some last-minute changes in ConceptMap: RH change in relationship types, new ValueSet to remove ambiguity. Directions of maps (very) explicit. No-map situation simplification. Element name changes. Choice datatypes in more places. ML property, dependsOn and product clarification. E.g. property is used in implicit ConceptMaps based on SNOMED complex maps. http://hl7.org/fhir/5.0.0-draft-final/conceptmap.html 2023-07-11 ML Added UP ticket - https://jira.hl7.org/browse/UP-436 (Unified Terminology Governance Project) | |
24 | MRCM in FHIR Machine Readable Concept Model (applies to both pre and post coordinated content) | MRCM is needed for writing good ECL and also for writing 'good' Post coordinated expressions. Going forward: suggestion that PJ and RH expose both the MRCM and the capabilities of ECL 2.0 with the wider HL7 and FHIR Communities. See slides on ECL 2.0 here. ML more generally this is a refinement axis which is represented as two things - the attribute and the range of values that that attribute can take.
2022-11-1 ECL 2.0 can retrieve MRCM refsets content, the question is how to return them as FHIR resources (structure map?) Using implicit concept maps may be an option to add operations such as get acceptable attributes or get range (note SNOMED is the only CodeSystem that uses implicit concept maps, wording around that is changing, see https://jira.hl7.org/browse/FHIR-39266 )
| ||
25 | Support for other CodeSystems in Snowstorm. | Confirmation that SI will be adding some support for other CodeSystems based on leveraging the existing HAPI library support for such things. Will be limited to the FHIR API (not the "native" Snowstorm API, except perhaps augmenting our return for ICD-10 maps to include the term associated with the code). This Will allow us to host the UK Extension due to the requirements of their extensive maps. Targeting August release of Snowstorm. Plan is to contribute code back where enhancement is required. 2022-08-23 See https://github.com/IHTSDO/snowstorm/releases/tag/8.0.0-beta (in use by India) 2022-10-18 PWI Pull request for this work to be merged into MAIN Snowstorm, priority of this under discussion. 2023-02-07 Just waiting for test plan completion before merge can be progressed. 2023-02-21 This work now merged from Snowstorm-X into the "develop" branch of Snowstorm Prime. | ||
26 | Upcoming R5 changes | 2022-8-23 RH R5 Deadline now September 4
2022-11-1 RB: Publication is expected after February 2023. 2023-02-21 PJ Reconcilliation to be completed by next week. | ||
27 | Topics for Terminology Binding Stream | 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? Oct 5 2021 Request for input from nutrition CRG. 8 Feb 2022 MAL Patient Care group proposing the use of an extension (specified by Daniel) to represent Allergy Type to add non-allergic hypersensitivity. MAL wondered about allowing a Codeable Concept there rather than a Code to allow for greater expressivity. Resource not planning on being Norminative in R5. 2022-11-1 DK: Immunizations may be a good candidate for future discussion MAL: can present advances. DK: Also, Specimen SNOMED vs Specimen resource. | ||
28 | Publishing SNOMED codes in IGs and licencing conditions. | 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?
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. 06 April: SR covid vaccines have been/will be incorporated into July release. They will be in GPS when ready. 8 Feb 2022 This was discussed at a CSRM meeting - Peter G. Williamsfollow up with Suzy Roy . DK Also do we specify boilerplate copyright statement? This should also be specified in our IG (or referenced). 2022-04-19 Beta release of the IPS sub-ontology (which will include relationships but not axioms) see https://www.snomed.org/snomed-ct/Other-SNOMED-products/sub-ontology-international-patient-summary due for Tues 3 May. ML concerned that having the codes in a different CodeSystem breaks interoperability - further discussion required on this point internally Kai Kewley Alejandro Lopez Osornio Suzy Roy 2022-11-1 RB: For the IPS Guide the copyright messages were reviewed, and approved by Suzy: Possible valid copyright statements used in IPS Implementation Guide, select and adapt the appropriate one depending on the content:
| ||
29 | Language Reference Sets in FHIR | All | Mechanisms for working with Languages 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 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.
Next Steps: How to promote - could we present at a Vocab call? (1530 ET Thursdays - may clash with SI Languages call) 8 Feb 2022 DK added Designation Extension into the SNOMED on FHIR IG see http://build.fhir.org/ig/IHTSDO/snomed-ig/StructureDefinition-designation-use-context.html | |
30 | 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
2022-11-1: No news, check in the next call. 2022-11-15 Suggestion to set page per meeting list to work through. Setting up one or two HTML style pages that could then be copied and modified and then use meetings to tackle more difficult content and review. Finding best publishing location, cross referenced between https://terminology.hl7.org/SNOMEDCT.html Pairings - Kai, Peter, Marie, Daniel, Rob Top Topics
2022-11-29 Example markdown page that could be copied and modified: https://github.com/IHTSDO/snomed-ig/blob/master/input/pagecontent/sct_specific_behaviours.md Work to be presented for 13 December (payment will be made in Glorytm) Peter & Kai - ECL in FHIR (Update: Used https://hackmd.io/ for collaborative markdown editing. ) Daniel & Marie - Allergy & Intolerance : (Update: Menu item added for extensions, confirmed examples are useful and appropriate for the Allergy Guide. ) Rob - IPS
2022-12-13 ECL Page reviewed - MarkDown not displaying the same as it did the IDE, revisit. Looking for some more structure that could be applied to the apparently unordered list of ValueSets (which is machine generated). Any documentation on how to do that would be appreciated. Other IG's we could compare to are : https://build.fhir.org/ig/HL7/US-Core/terminology.html & http://build.fhir.org/ig/HL7/fhir-ips/ ( also http://build.fhir.org/ig/HL7/fhir-ips/terminology.html )
2023-02-07 MAL work for Allergy Implementation Guide (which the SNOMED IG will link to) see SNOMED CT Implementation Guide for Allergy, Hypersensitivity and Intolerance 2023-02-21 DK Work done for languages - https://build.fhir.org/ig/danka74/snomed-ig/branches/languages/ Discussion about overloading of parameter for both display language and search language. Checking behaviour around fall-back on displayed terms (eg context specific → national language → English). For example, display parameter being a comma separated list (which has a defined order, unlike repeating the same parameter multiple times (also not allowed in the spec)). | ||
31 | 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 http://snomed.info/sct/* (ie not specifying the version) or http://snomed.info/sct/*/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. 25 Jan 2022: Snowstorm will already look across all Editions loaded when a codesystem version is not specified, eg: https://browser.ihtsdotools.org/fhir/CodeSystem/$validate-code?coding=http://snomed.info/sct|443971000124108 only exists in the US Edition. (See also the History proposals for ECL)
2022-05-17 ML Ontoserver supports ValueSets that draw from more than one version, so you could use that to compute the difference between one version and another. 2022-11-1: DK: Snowstorm does not yet support multiple include elements in different versions for the SNOMED code system. ML: The semantic is not yet clear, how to decide in which versions you check properties, parents, etc. Run separately for all inclusions and join the results. May need to understand better the use cases. | ||
32 | Long 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 https://www.hl7.org/fhir/r4/codesystem-snomedct.html PWI discuss internally - done. Update 21 September 2021 - General agreement that that page can be removed. Is out of date and not serving useful purpose. Update 25 Jan 2022 - HL7 intend to make The THO https://terminology.hl7.org/ a home for all terminologies and valuesets. Next Time: Move to archived discussion, make note in IG 2023-03-07: RH Vocab WG has a new name: Terminology infrastructure WG | |
33 | IPS / GPS progress | IPS Terminology Subontology - beta went out 2 weeks ago, now in feedback until June 30. Publication for the end of the year. ML expressed issues around not being conformant to RF2 spec but is missing module dependency file. ModuleId is present but invented Concept. ALO/SR suggested ML give that as feedback. GPS expected towards the end of September. Currently working with contributing organisations, which will then go to internal authoring. ALO GPS may turn out to be less useful and focus could be on IPS in future. 2022-10-18 See https://gps.snomed.org/ also available in MLDS, published 2021-09-30, based on INT 20210731 PWI will follow up for 2022's copy. SR IPS targeting Nov 30 2022. Sub-ontology steering committee (internal) meeting next week. 2022-11-1: RB ML have received a new beta version and are testing. ML: The effective time in MDRS may be pointing to July instead of November. No MRCM content, it is required fur the type of the concrete domain attributes. 2023-03-07: IPS has a new management process. Feedback received will be managed by the most appropriate SDO. | ||
34 | Snowstorm post-coordination updates | 2023-03-07 Post-coordination is added to the FHIR API and more (include $lookup, $validateCode, $subsumes, etc.). Will be published together with the Post-coordination guide. 2023-06-13 Post coordination support now available in Snowstorm-X see https://github.com/IHTSDO/snowstorm-x | ||
35 | Any Other Business |
|
Potential Items for Discussion
Description | Owner | Notes & Actions | |
---|---|---|---|
Concluded Discussion
See also FHIR Terminology Services Discussions
Description | Owner | Notes & Actions | |
---|---|---|---|
Meeting Files