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20:00 UTC on Tuesday 6 August 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


Jeremy RogersRob Hausam


Peter G. WilliamsAndrew Perry

Meeting Recording

Discussion items



OwnerNotes & Actions
1Welcome and introductions5

Recording + Notes.


Summary of previous week (TS) and previous TB

3Future meetings

  • Jane Millar To draft abstract for October Expo presentation

Next FHIR DevDays Amsterdam, November 20 – 22, 2019

4Free SNOMED CT Set for FHIR50

Free SNOMED CT set for FHIR

25 June. Grahame keen to see work done on both sides to bring us closer together in the ValueSets concerned with clinical safety:

-          AdverseEvent.outcome (red)

-          Condition.clinicalStatus & AllergyIntolerance.clinicalStatus (amber) These are the same items although in separate Valuesets. HL7 could discuss making them a single ValueSet.

Grahame looking for times for a face to face meeting, see Zulip.

  • Rob Hausam Feedback on Amber mappings - feeback expected 16 July (after HL7 15)
  • Peter G. Williams Jane Millar to arrange a 2 hour meeting with interested parties in August (giving us a chance to set out the issues, and DK will be back).
  • Jane Millar to speak to Jim Case about adding FSN & Synonym into free set - is currently used in ValueSet expansion.
5Observation resource30

See updates here: Observation binding

6Exemplar ProfileX

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:

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.

28 May: Plan to publish profile for the October conference (8 sessions + working between meetings. Completion for review Tues 14 October (or earlier since we'll need time to complete the IG?)

  • Build implementation guide
  • Setup FHIR server with relevant valusets

Tooling for profiles: Forge (.NET) is now R4

  • Daniel Karlsson to try loading existing Allergy Intolerance profiles into Forge R4. The STU3 profiles loaded fine in Forge R4 as just STU3 profiles. There are almost no changes between STU3 and R4 for AllergyIntolerance, so by manually changing the XML files from "3.0.1" to "4.0.0" the files showed as R4 profiles with no errors displayed. Files uploaded to profile page.
  • Rob Hausam to take Observation questions to OO group.

RH: Suggestion that "published" valuesets would be read-only.




Revisit any outstanding questions on Allergies.

External publication of v0.1 of the AllergyIntolerance resource

8Vital 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.

10Next meeting5

20 August

Meeting Files

  File Modified
PNG File image2019-6-26_10-43-2.png 2019-Jul-25 by Peter G. Williams

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