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20:00 UTC on Tuesday 5 February 2019 - 90 minutes.


  • Bindings to FHIR Clinical Resources (e.g. value set bindings)

Meeting Details


Phone: See for available phone numbers (meeting id 242-348-6949)

Chat: #snomed-hl7-fhir

Discussion items



OwnerNotes & Actions
1Welcome and introductions5

Recording + Notes.

2Face to face meeting at the April Conference1

Sunday 7 April 13:30 - 17:00 UTC

Agenda: 2019-04-07 - SNOMED on FHIR Meeting (TS & TB)

3Deliverables for April Conference & ongoing interaction with wider HL7 projects.10

Request received for documentation of progress and process.

  • Write up 3 groups of work - Green items to GG, Yellow items with questions to HL7 and questions for SNOMED International to appropriate group.

Sharing our output with HL7 - specific output or questions for Rob?

Split: What needs to be addressed by SI and what should be passed over to HL7? Staged / Iterative approach suggested. Severities currently green - shall we start there. Communicating this to: GG (if we go to Patient Care, it would need context supplied which RH could give). 3rd option is FHIR Infrastructure Work Group. Agreed GG in first instance. HTA is considered to work at a more strategic level.

RH suggested mapping based on the stated definition of the code in FHIR ie where no strict definition is given then a strict lexical match is sufficient, but where full definition is given our mapping should be commensurately specific.

DK: We should include (consider) previous mapping work done by LB and GG - FHIR Expression Templates. So individual value mappings exist within the context of a wider information model mapping.


Summary of previous week (TS) and previous TB

5Update on HL7 Meetings10

Meeting with Keith & Grahame (notes by Daniel Karlsson):

Keith Campbell and Grahame Grieve are only interested in equivalences between FHIR concepts and SNOMED CT concepts (how equivalent is equivalent?) and thus we should aim to sort the cases into equivalent and non-equivalent. Keith’s intention is to allow (some?) reasoning across FHIR and SNOMED CT representations, with likely significant impact on the SNOMED CT concept model. If we can move from amber to green, that’s good but if it’s not possible it’s not possible. When we have agreed on a list of equivalences HL7 will take the rest and create SNOMED CT concepts in their extension to allow (partly?) representing FHIR CodeSystems content in RF2. SNOMED I will publish the set of equivalent SNOMED CT concepts as a free for use set.

We might still discuss what is our equivalence threshold, from lexical to concept-model equivalence, but I suggest that we limit the number of additional meetings we spend on this topic.

Jane: Clarified the function of the SNOMED on FHIR group with the HTA. Keith's use case is in transferring data between companies, so a shared extension would help with this. HTA discussion on how to input to this group - SNOMED on FHIR may be added as official project to HL7's list - RobH progressing.

Daniel: This group is being asked to check alignment and provide list of "Red" value sets to HL7 so that they can add concepts to SNOMED in some extension. Question around how much 'context' is included in our selection of concepts (on both sides).

Jeremy: Notes that mapping to only certain qualifier values could lead to records not being found if some wider SNOMED CT set of values is used which wouldn't match with a reduced set via FHIR. We should include discussion of how this map should be used in various situations.

Rob: FHIR R4 published in December. R5 work underway (ML: watch concept map going normative!), targeting Q3 2020. Lots of IGs being balloted (eg IPS). See list of resources going normative at

6Free SNOMED CT Set for FHIR20

Free SNOMED CT set for FHIR

  • Are the mappings suggested complete and ready as a recommendation?
7Exemplar Profile20

Publishing Profiles

  • Wrapped by implementation guide - in this case
  • Value set publish to a live SI hosted Snowstorm instance. Alternatively Michael Lawley has offered to host.
  • Additional hosting on Simplifier (STU3, not yet R4 - January?)
  • Suggestion to review work already done to ensure R4 compatibility
  • Would value sets also be published as reference sets? Maintain via Refset tool and published in MLDS. Note: UK experienced substantial 'getting off the ground' effort in this area. Sweden have worked through ~10 (will request promotion of content to International Edition where appropriate).
  • HL7 FHIR Registry?
  • Option to have multiple profiles available at the same time using slicing.
  • Chance to do some technical work at HL7 San Antonio
8AllergiesXRevisit any outstanding questions on Allergies.
9Vital SignsXDaniel Karlsson

Vital Signs Resource

Jeremy's work to compare Vital signs profile and SNOMED Subhierarchy - issues with eg blood pressure. Complex expression constraints available which cover the use of observables by the NHS(UK). Mapping to LOINC codes.

See Spreadsheet attached to: SNOMED on FHIR Meeting (TB) - Tuesday 21 August 2018

Issues / Discussion :

  • Normative vs. descriptive purpose - 1, 2, or 3 profiles?
  • Unresolved modeling issues





v3.4.0 (publication Aug 19?)



Neither of these exist in the FHIR 3.0.1 Spec. Rob Hausam


  • What determines which FHIR resource to use: the location of the data item in the sending system’s information model, or the semantics of the particular code regardless of where it was found? Some hybrid of both?
  • If the resource to be used is determined at least partly by the location in the sending information model, how does a requesting system cope with the fact that different implementations (or different users of the same implementation) both can and do secrete essentially the same clinical info in very different parts of the host information model?
11Next meeting5

Tuesday 26 February 2019 (Agreed to skip a week due to several members taking vacation)

From Bruce Goldberg: "It might be useful for the Allergy CRG  to be part of these discussions. I am going to be holding a ½ day Allergy CRG meeting during the London conference. Would it be helpful to start a discussion there and if so, who can attend?"

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