Date 20:00 UTC on Tuesday 17 October 2023 - 60 minutes.
- FHIR Terminology Services and Resources
- FHIR Profiles & Terminology Binding
Passcode (not required when using link above): 32075
Chat: public-snomedintl.slack.com # snomed-hl7-fhir (ask for invite!)
|Notes & Actions
|Welcome and introductions
Recording, notes & attendance.
Check questions in Zulip and SNOMED International #snomed-hl7-fhir
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
Agenda for Business Meeting
SNOMED + LOINC Update: https://loincsnomed.org/
FHIR Tracker from Rob Hausam : https://jira.hl7.org/browse/FHIR-28233. (Supplement adds new properties and - for example - descriptions to existing codes. It cannot add new codes. Fragments is a publication of a subset of a CodeSystem. Fragments could include post coordinated content). We can offer Compositional Grammar - Specification and Guide short/stable link: http://snomed.org/scg and also Practical Guide to Postcoordination http://snomed.org/postcoordination. What is it, why is it useful and where do I go to find out more?
Daniel Karlsson results of HL7 EU Ballot on https://build.fhir.org/ig/hl7-eu/laboratory/branches/master/artifacts.html#7
New Slimline Agenda
See discussion pages for links to archived discussion: Discussions
|General discussion on work being done in EU
2023-09-19 ML CSCT now has official "Not for Profit" status as an entity.
|IG Tooling Compatibility
Requirements for making a Terminology Server compatible with IG Tooling
2023-10-03 ML Ontoserver still a work in progress in this area.
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.
There was an inconsistent role grouping pattern in the observables, and the question was trying to find the reason for this. This is being evaluated.
Peter G. Williams There is a decision to move to the grouped pattern
Andrew Perry looking for opportunities to contribute to the observables and LOINC modeling decisions
2023-09-19 Update: Direction of travel here suggests moving to have all attributes in a single role group, but preparatory hierarchy movements will be required first - Evaluation Procedures moving to Observables. Discussion expected at October MAG meeting, followed by a briefing note if no major objections raised. AP UK have concerns about problems caused with existing counterparts between the two subhierarchies. UK did respond to RFC last week.
2023-10-03 SI responding to briefing note feedback (including encouragement from UK to engage as a matter of priority). Discussion expected in both MAG and EAG at October Business Meetings. Two Schools of Thought: LOINC style single observable hierarchy (order / result) vs. procedure + observable pairs for expressing ordering and results.
|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 184.108.40.206 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
XpanDH - 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.
2023-10-03 ML News update on course proposals expected for November. See https://cordis.europa.eu/project/id/101095594
|Language behaviour compliance in Snowstorm
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.
|R5 changes suggested around specifying language using BCP-47
See Tuesday meeting item #6
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 $expand operation
2022-08-31 ML CSIRO attempting to get R5 compliant Ontoserver ready in time for HL7 Connectathon.
Also tracking R5 changes to concept map - see http://build.fhir.org/valueset-concept-map-relationship.html. Peter G. Williams to check SI intention for R5 compliance.
2022-10-18 DK EHealth Working Group on Semantics - discussion on cross border infrastructure based on CDA. Suggestion that it could move to FHIR for new specifications/developments eg Lab Reports.
2022-11-02 RH Rob will check the status and how we can help it move
2023-02-07 RH R5 Ballot is complete. Deadline to complete resolutions is Feb 24th. Expectation to publish late April / early May.
2023-03-07: RH R5 going through QA currently. Some last-minute changes in ConceptMap: RH change in relationship types, new ValueSet to remove ambiguity. Directions of maps (very) explicit. No-map situation simplification. Element name changes. Choice datatypes in more places. ML property, dependsOn and product clarification. E.g. property is used in implicit ConceptMaps based on SNOMED complex maps. http://hl7.org/fhir/5.0.0-draft-final/conceptmap.html
2023-07-11 ML Added UP ticket - https://jira.hl7.org/browse/UP-436 (Unified Terminology Governance Project)
|Language Reference Sets in FHIR
24 August DK Added pull request to Snowstorm here
Implementation by ML using existing fields and specifying LangRefset in displayLanguage parameter with "preferredForLanguage" code and wildcard Eg https://r4.ontoserver.csiro.au/fhir/ValueSet/$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
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 )
|SNOMED FHIR Implementation Guide
IG Documentation: http://build.fhir.org/ig/FHIR/ig-guidance/index.html
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
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)).
2023-10-16 PWI Update: We had a note to follow up on https://www.hl7.org/fhir/R4/valueset-animal-breeds.html as these have mostly been inactivated and moved to the Veterinary Extension. In following up, it was determind that this valueset is no longer present in the FHIR core as of R5.
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.
Michael Chu - let's discuss.
|Any Other Business
2023-10-03 ML working on registration of congenital abnormalities - is there a way to group disorders (eg as part of a syndrome), specifically in the Condition Resource to (See Condition Related Extension in R4 http://hl7.org/fhir/R4B/extension-condition-related.html / http://hl7.org/fhir/extensions/StructureDefinition-condition-related.html ) See https://hl7.org/fhir/extensions/extension-registry.html also condition-dueto. JC Syndrome is just a grouper name, it doesn't "cause" the manifestations as such.
Potential Items for Discussion
|Notes & Actions
|SNOMED Family of Languages
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 wo (ld allow multiple filters in multiple/different languages.
|Specify CodeSystem in FSH
|FSH apparently has no way of specifying the version of a CodeSystem. Daniel checking the ANTLR spec. https://github.com/FHIR/sushi/issues/473
|API for FHIR Resource ↔ Post coordinated expression mapping
|Looking up an SCTID in an unknown module
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.
|See Discussion on Global Patient Set (GPS)
|$lookup operation - properties returned
Using http://ontoserver.csiro.au/vstool/ I noticed that both Ontoserver and SnowStorm return a SNOMED CT $lookup property for effectiveTime, which I don't see listed, as one of the SNOMED CT properties in the FHIR R4 specification at http://hl7.org/fhir/snomedct.html. Should we create a Jira TIcket to add this?
Completed - https://jira.hl7.org/browse/FHIR-26555
|Use of url parameter
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
|ECL in the Valueset Expression Extension
Check whether SNOMED ECL is (or should be) registered as a MIME type (as per RFC 4289/BCP 13), or alternatively added to the expression-language code system and value set, for use in the valueset-expression extension used with the ValueSet resource.
For example, HL7 have registered application/json+fhir
This is useful for a ValueSet extension which allows any language to be used to define the selection criteria for an intensional definition using a MIME type. This group has no current reason to use that extension given the existing core specification support for implicit ValueSet definition and the support within the compose element.
RDF community may have an interest.
Update 2 June RH: Existing small valueset extended in BCP13 (existing known codes could be published as a CodeFragment). Vocab Working Group discussion ongoing.
|Behaviour on Lookup
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
Point of interest: Grahame's server returns a copyright property.
Update 7 April - Question about whether this is required / desirable?
|Notes & Actions
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
|New parameters proposed for streamlining operation of expand and validate 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.
|FHIR Server Federation
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.