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20:00 UTC on Tuesday 26 March 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.


Summary of previous week (TS) and previous TB

3NHS Connectathon in Bradford5Jeremy Rogers

Any background Jeremy Rogers ? Particular interest in what server they're hosting here.

"NHS Digital are working to establish a National Terminology Server for organisations to use for retrieving codes, terms and their relationships to each other. The Terminology Server will enable dynamic population of user interfaces, underpinned by standard local, national and international terminologies and code systems, such as SNOMED CT, ICD, OPCS and NHS Data Dictionary.

NHS Digital are hosting a 'Connectathon' event in Bradford on 2nd/3rd April that will include an update on our proof of concept work and enable attendees to learn about FHIR and terminology services and capabilities."

Sorry Peter G. Williams I don't know. I suspect that the current PoC will remain based on OntoServer, as per the London Connectathon event last year. But I believe any subsequent move toward a persistent national server solution offering would require going back out to full open tender. I hear rumours that this tendering may happen in the Autumn or possibly later.

4Face to face meeting at the April Conference5

Sunday 7 April 13:30 - 17:00 UTC

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

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?"

  • Who's on the call who's going to be able to give an update?

Peter Jordan for NZ

Michael Lawley for Australia

Andrew Perry for UK

Rob Hausam for US (and Finland!)

Daniel Karlsson for Sweden

5Deliverables 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, Amber items with questions to HL7 and questions for SNOMED International to appropriate group.
  • Jane Millar To write overview - draft to RH, DK, PW

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.

6Free SNOMED CT Set for FHIR20

Free SNOMED CT set for FHIR

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

Peter G. Williams suggest merge items 4 and 7 for Sunday meeting at Conference

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

Options for Profile discussion:


Allergy IntoleranceCondition
MedicationVital SignsProcedure



Notes 26 Feb: UK working on pathology reporting - diagnostic / observation.

Suggestion that we try out two types of profile, both of which avoid issues of conflict between fields within the information model:

  1. Where we only use the code field for clinical content (plus the administrative fields)
  2. Where we restrict the code field to atomic values and all other resource fields should also be populated. Note that this does not solve the role group problem.



Revisit any outstanding questions on Allergies.

Peter G. Williams can we have 20 mins scheduled at the London meeting to discuss how to progress external publication of v0.1 of the AllergyIntolerance resource

9Vital SignsXDaniel Karlsson

Vital Signs Profile of Observation 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?)



These two separate resources existed in the FHIR 3.0.1 Spec. Rob Hausambut have been removed in 4.0 and replaced with ServiceRequest


  • 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?

Need to revisit the original questions raised in this group wrt the two separate resources of yore, and consider whetehr the same issues persists wrt the new single ServiceRequest resource.

11Next meeting5

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