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20:00 UTC on Tuesday 8 October 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
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.

Closed TB Small working group arranged for the Sunday AM to address proposed solution for FHIR Free Set mapping issues.

Michael Lawley, Daniel Karlsson and Rob Hausam have been entered for a "SNOMED on FHIR" presentation for the Thursday. Topics included to be: Free Set, Implementation Guide and Profiles. Complete before Sunday 27 October (Peter G. Williams to submit the file)

  • Jane Millar Deadline of 14 October to upload FHIR presentation for Expo
  • Peter G. Williams Setup Presentation template (Google Slides) and email out.

Update 8 Oct: DK suggested 10 5 minutes per participant.

Expecting to skip call on 29 October due to KL Business Meeting. Calls as normal until then. Schedule will skip one week so TS/TB will need to swap. Also watching out for Day Light Savings changes. Time of meeting UTC will remain unchanged.

Upcoming events: FHIR Dev Days Nov 20 - 22 2019 Amsterdam

2 - 3 Feb 2020 HL7 Sydney

Priorities for Events: Working with languages, hosting the GPS legally, ConceptMap$translate (new relationship types)

4Concept Map - Mapping Relationship5

Concept Map - mapping is made from source to target but the relationship is interpreted from target to source eg "broader" is to say that target is less specific than the source. Is this reversal causing confusing

Feeling of the group was that the existing implementation (ie "mapping relationship is about the target") is the more intuitive and we just need to highlighted that sooner rather than later (the specification is already considered to be clear on this topic). Note that the mapping relationship is a sub property of the match element itself ie the target. and

SNOMED CT has similar functionality in Complex Maps with the correlationId field which takes << 447247004 |SNOMED CT source code to target map code correlation value (foundation metadata concept)|

DK Thought that the terms used here come from the linguistics domain which may explain some of the trouble here.

RH Adds from SKOS: Note on skos:broader direction: for historic reasons, the name of the skos:broader property (the word "broader") does not provide an explicit indication of its direction. The word "broader" should read here as "has broader concept"; the subject of a skos:broader statement is the more specific concept involved in the assertion and its object is the more generic one.

Tracker on this: #16364

5Behaviour 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 to note that FSN and Preferred Term concepts are now part of the GPS therefore licence restrictions no longer apply.
  • 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. Is this really needed? Do we just need to specify a table in the IG of what parameter to specify and what to expect back in each case.

6SNOMED 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.

  • Peter G. Williams Rob Hausam to bring SI's IG into line with current tooling expectations.
  • Rob Hausam please help with telling IG tooling to render the entire StructureDefinition from the base resource not just the delta fields as we see here. DL says the resource made more changes than this.

7Mechanism 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.

Peter Jordan's implementation can take a refset Id (which is more flexible for dealing with same-language designations such as dialect and patient friendly terms ```includeDesignation = SYSTEM+<SCTID>```

Problem: We can't tell the difference between Preferred and Acceptable. Currently the best we can hope for is to use array ordering.


Any other business

Next meeting 12 Nov (note skipping a week so TS / TB meetings will change week)

Potential Items for Discussion

DescriptionOwnerNotes & Actions
API for FHIR Resource ↔ Post coordinated expression mapping

API for FHIR Resource to SNOMED Expression

  • Daniel Karlsson Thought there might be some documentation from CIMI on this. Also notes from DMarkwell about constructor bindings.
  • Peter G. Williams Pull these notes into confluence - can we mention it in the IG?
Looking up an SCTID in an unknown module

Problems when dependencies do not align. Multiple code system resources represent multiple editions / versions.

ML: See code parameter to code system search. Should return code systems (ie versions) where that code is defined. International concepts would appear in every edition known to the server.

eg /CodeSystem?system=htp://

See Discussion on Global Patient Set (GPS)

Meeting Files

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