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20:00 UTC on Tuesday 16 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.

Update 15 July - HL7 Meeting didn't occur.

  • 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.

  • Peter G. Williams restrict free set discussion to TB calls. Possible fail for this week, remove this item for future agenda.
5New 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).

6Behaviour on expansion regarding which description type to return.20Peter Jordan

Terms that are returned when requesting implicit valuesets. Snowstorm returns FSN, Ontoserver returns Preferred Terms.

ML: Intention is that this list would be used to populate a resource and so the PT is appropriate "The best display is the preferred". DisplayLanguage parameter should be used for the client to specify what they want - how would we use that for FSN vs PT vs Other (eg Patient Friendly Terms)?

Designation parameter should be used to recover the FSN (pulls from Designation Use ValueSet)

  • Rob Hausam add to agenda for discussion (Designation Use ValueSet) in Atlanta (Sept)
  • Peter G. Williams rework Snowstorm to return PT by default and FSN as additional designation when designation parameter is present

Group's current interpretations is that includeDesignations=true (with no other designations specified) would return all designations whereas specifying the specific designations is a request to return those specific designations.

Note for Vocab group that although 900000000000548007 |Preferred (foundation metadata concept)| exists, we do not ( ?) have a concept to represent patient friendly terms.

Note issue with licence restrictions in ValueSet. Tracker needed to remove text -

  • Reuben Daniels to raise tracker.
  • Jane Millar to note that additions to this ValueSet would require adding << 900000000000511003 |Acceptability (foundation metadata concept)|
  • Peter G. Williams add to agenda for KL
7SNOMED FHIR Implementation Guide60



Rob Hausam Please add documentation on running updated tooling.

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.

8Mechanism 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.


Any other business

Next meeting 30 July

Meeting Files

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