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20:00 UTC on Tuesday 2 July 2019 - 90 minutes.   


  • FHIR Terminology Services and Resources

Meeting Details


Phone: See for available phone numbers (meeting id 242-348-6949) # snomed-hl7-fhir (ask for invite!)

Discussion items



OwnerNotes & Actions
1Welcome and introductions2

Recording, notes & attendance.

2Summary of previous week and previous fortnight10

Note Daniel away for 3 weeks after the 11th so keen to have meeting despite overlap with FHIR Dev Days (FYI Jeremy Rogers)

Discuss option for summer break. Peter G. Williams away 30 July, back for 27 August.

SNOMED International retreat 23 July

3Other Meetings10

SNOMED Expo Oct 31 - Nov 1 Kuala Lumpur

Thursday half hour session. Title of session: "SNOMED on FHIR" Content: Profiles (eg Allergy Intolerance), Free Set, Implementation Guide, discussing and sharing.

Sunday morning for HL7 Vocab "alignment" session.

  • Peter G. Williams Look for space for additional face to face meeting with HL7 Vocab members.
4Publication of FHIR Free Set

Free SNOMED CT set for FHIR

Green - Grahame to provide feedback for next week. Update 2 July feedback was received, Grahame has asked us to look again at 3 ValueSets of interest to patient safety.

Amber - documents going to Patient Care Group.

Update 23 April: Terminology Binding group moving on to remaining Valuesets.

Update 18 June: JC Parts of finding hierarchy contain context that can put us at odds with a hierarchy that FHIR might want, and this context (ML) may not be visible in the FSN.

  • Peter G. Williams Jane Millar discuss arranging wider call with other members of Vocab for some TB week when Daniel is back (August?) - after framing of issue and specific goals for this.

Update 2 July JM: Will be maintained in the Refset tool and made available to HL7. As with all derivatives, will be released once per year unless required otherwise.


New Topic

Expand operations parameters

15Peter G. Williams

Has anyone implemented "Context" ? Yes, ML.

6New Topic5

Proposed changes to ConceptMap resource:

Issue when there is equivalence between source and target. See tracker item:

7 Changes proposed to ConceptMap. is going to change to "relationship" and the type of the relationship stated - new Valueset conceptMapRelationship (previous VS retired). Relationships enumeration will be: relatedTo, Equiv, Broader, Narrower, Not Related

ML - this has implications for $closure (which returns a concept map which uses other values eg subsumes).

RD: "Unmapped" is to be used by default when there is no target. Tracker to give advice on how to work in this resource with FHIR extensions.

Update 2 July - RH Changes not applied yet. ML Impact on $closure will need to be removed (those values are removed in this proposal).

7New Topic10Rob Hausam

Clarification needed of the reverse flag in ConceptMap $translate

Returning concepts from the "source" valueset where the code supplied is a member of the "target" valueset. Ontoserver (for example) will treat the "source" valueset as the target when no target is supplied.

  • Rob Hausam Vocab meeting this Thursday, will mention that further clarity is required here on what is expected in the source and target parameters when the reverse flag is present. Update 2 July: Vocab group have a proposal for improvement

changes for 'code' input parameter:

If 'reverse'= 'false': The code that is to be translated.

If 'reverse'= 'true': The code that is translated to.

If a code is provided, a system must be provided

changes for 'reverse' input parameter:

If 'reverse'  = 'false': The operation returns all of the codes that have mappings from the code that is specified in the 'code' input parameter

If 'reverse' = 'true': The operation returns all of the codes that have mappings to the code that is specified in the 'code' input parameter.

changes for 'source' input parameter:

Change the first sentence to "Identifies the value set that contains the concept(s) to be translated.

Forward translate source = SCT, code = 1234500, Target = ICD-10 we're returning ICD-10 codes eg (ABC-1)

Reverse source = SCT, code = ACB-1 ,Target = ICD-10 but we're returning SCT codes

8New Topic10N/A

Follow up discussion on finding all refsets that a particular concept is a member of (relates to both $expand $lookup and ECL) eg ^( << simple refsets). Simple refsets and simple map would check the referencedComponentId, but there may also be a case to find references to other fields.

PWI spoke to Linda who is interested to know the use cases. ML says it's a proxy for the importance of the concept ie is it in wide use. Can also give a sense of where it is used, and by whom.

PJ has suggested (as an alternative to enhancing ECL for this) that a standard property (ie a well known) for a SNOMED code could include a list of all reference sets which include this concept. Note that language reference sets are not a good example because they reference description ids (double indirection).

9Non-defining relationships (ie additional characteristic type eg Part Of, now inactive)5Peter G. Williams

Should non-defining relationship show up as properties in a lookup. The question of whether or not ECL will consider these is delegated to the choice of substrate, but the default substrate does not (?) specify if they are or not.

10SNOMED FHIR Implementation Guide60



Progressing the SNOMED Implementation Guide and specific guidance of "Best Practice" of using SNOMED with FHIR. Can we include tests for 'correctness' - using existing FHIR Testing platforms? with the built view hosted by GitHub at

Tooling: Current tooling appears to be solely command line based. See also Snapper for value set editing (currently STU3).

What is the scope of content for the guide? Targeting "Best Practice" for FHIR Implementers using SNOMED CT. Possible layered approach and potentially strict (for internal record keeping and communication) vs permissive profiles when . General guidance for bindings or specific details on each resource.

Audiences - Developer vs User of implemented services. ML Suggests single entry point document with multiple paths through the documentation.

8 January 2019 Update:

Tooling: Forge (doesn't support R4)

What do we want to say about how SNOMED should be used in FHIR? Eg On the Terminology Services side, start with a narrative and head towards a test script where a particular query is expected (formally) to return a given set of results. Then on the resource side, talking about what particular value sets should be used for specific resources - condition code being a high value. Will we insist that these are SNOMED code or could they be proxy codes eg where a medication is given on a problem list and - in it's presence - indicates the underlying condition but without specifying that explicitly.

Start with a Confluence page for collaborative work and once that's reached some stage of maturity it can be moved into the GitHub repository in a more structured form.

Are we looking at one implementation guide or two? Terminology Server vs Terminology Binding and Profiles.

11Mechanism for working with Languages.15Reuben Daniels

Mechanisms for working with Languages

Michael Lawley has raised ticket about the "use" field being limited to FSN/Synonym. Elsewhere in FHIR there is a "display" code that can be used to indicate other languages See 22490. Also 19960 - additional term for "Consumer Terms" ready for implementation R5 (Q4 2020 at the earliest).

18 June PWI gave some notes from pop-up session at FHIR Dev Days - more about locale than language. ML: "Translation" extension doesn't allow for a particular piece of text being in a different language from that of the resource.

12Ongoing items10
  • SNOMED CT Canonical CodeSystem resource
    • Outstanding question of whether this is the Canonical CodeSystem for the International Edition, or some base set of properties for all Editions.
    • How is this distinct from the Terminology Capabilities Resource?
    • Review and attempt to resolve detail questions
    • Update 28 Aug: Official endpoint should be hosted somewhere (SI?)
    • Update 13 Nov: (ML) We should publish as part of the IG - possibly two - a) International and b) a template as guidance for implementers. In the event of a choice of versions, suggest the default is to return the most recent available.
  • Using SNOMED CT with FHIR

Collaborative Work

On Hold / Maintenance


Any other business

Next meeting 16 July

Meeting Files

  File Modified
Microsoft Excel Spreadsheet FHIR Connectathon 18 Terminology Formal Tests Version Parameters.xlsx 2019-Jul-02 by Peter G. Williams
Microsoft Excel Spreadsheet FHIR Connectathon 16 - Additional Terminology Server Tests.xlsx 2019-Jul-02 by Peter G. Williams
Microsoft Excel Spreadsheet FHIR Connectathon 17 - Additional Terminology Server Tests.xlsx 2019-Jul-02 by Peter G. Williams
PNG File image2019-1-29_20-18-40.png 2019-Jul-02 by Peter G. Williams
PNG File image2019-1-29_20-15-2.png 2019-Jul-02 by Peter G. Williams