Peter G. Williams

Rob Hausam

Recording, notes & attendance.

Check questions in Zulip and SNOMED International #snomed-hl7-fhir

Peter G. Williams

Rob Hausam

Peter G. Williams

Rob Hausam

All

Peter G. Williams 

Daniel Karlsson 

Rob Hausam 

Kusal Wijayaweera 

Rob Hausam 

Feikje Hielkema-Raadsveld 

Kusal Wijayaweera 

Maryam Razavi 

Alejandro Lopez Osornio 

Katharine Priest 

Daniel Karlsson 

Daniel Karlsson 

Katrien Scheerlinck 

Kusal Wijayaweera 

Kusal Wijayaweera 

Alejandro Lopez Osornio 

All

Misc Discussion

Internal discussion on languages in general and specifically latin words.  MAL suggested looking at https://iate.europa.eu/home which includes latin.  See Latin Terms - Discussion

Snowstorm-lite revisited (see 2024-01-09 - SNOMED on FHIR Meeting (TS & TB) )

URIs and Identifying Modules - "Edition identifier" - this is the full URI, not just that module. "Most dependant module" - yes but fails in the International Edition.  "Identifying Module". "Root module" - Not always the top/bottom of the hierarchy.

Discussion on adding / removing modules to / from packages.   Check on license conditions allowing for automatic promotion to ensure interoperability.

Discussion on expansion related to 5.2.1.7 Query Specification Reference Set.  ML Could we try to expand the referenced component id, ie look in this refset if no refset members are initially encountered?  MLO Canada is already doing this and they have pre-expanded simple reference sets.  KK Snowstorm does not use this reference set.   LB An extended version of this refset has been drafted which allows the substrate to be specified.  

Peter G. Williams 

See discussion pages for links to archived discussion:  Discussions

Kai Kewley 

Moved in from "Potential Topics": 

API for FHIR Resource to SNOMED Expression

See also discussion on URIs for PCEs. 2024-03-05 - SNOMED on FHIR Meeting (TS & TB)

Daniel Karlsson 

ICD-10 Complex Map in ConceptMap$translate (see agenda item 18 2024-03-05 - SNOMED on FHIR Meeting (TS & TB) )

DK Suggests using match.product for each additional item with a URI for each column in refset as per 2.6 URIs for Properties

KK The R4 Products are flat and various ICD-10 rules are grouped.  Example here:  https://snowstorm.ihtsdotools.org/fhir/ConceptMap/$translate?code=421671002&system=http://snomed.info/sct&targetsystem=http://hl7.org/fhir/sid/icd-10

Marie-Alexandra Lambot

Question:  Can we do cross field validation of FHIR resources, to restrict valueset available for one element dependent on the value entered in some other field.

DK Do this using "Invariants".  See https://build.fhir.org/conformance-rules.html  and https://build.fhir.org/profiling.html#slicing (complex approach!)

ALO FHIR Questionnaires have more support for cross field rules.

LB - would specify this in the Implementation Guide with the specific rules.

STEFAN SCHULZ 

ValueSets eg for procedures which recommend SNOMED CT codes that have been retired.

ML: ValueSets described via enumeration will need to be kept updated.  The party that specified the ValueSet is primarily responsible for maintenance.

RC: License requirements do imply that SNOMED CT versions should be kept up to date in systems. 

Marie-Alexandra Lambot

Katharine Priest  

The new implementation course could focus on SNOMED + FHIR, and transformations between information models, using maybe the Allergy demonstrator as an example. Maybe adding consideration on adding LOINC concepts, like the allergy test using LOINC (Observation in FHIR).

Suggestions: add onset to reactions (date), and use problems already recorded for reactions manifestations, and vice-versa.

Helpful Introduction Videos:

Introduction to SNOMED with FHIR YouTube recordings of Dev Days Presentations:

https://www.youtube.com/watch?v=40Lvv2t8OxU

https://www.youtube.com/watch?v=x6UqJtcJwmQ

https://www.youtube.com/watch?v=8cXRAtNoSvc

Ronald Cornet 

Michael Lawley 

FHIR for Terminology vs FHIR for Patient Records - eg for cohort identification.  See https://www.hl7.org/fhir/search.html#modifierin can try out on https://hapi.fhir.org/ Also CSIRO Pathling server for analytics 

Navigational ValueSets - how can you express hierarchy and/or grouping in a ValueSet expansion?  Nested code can be used to show hierarchy (navigational concept could be represented as blank).  Question is more about how you initially input that structure such that it would take effect.  Note that valueset composition (valueset containing valuesets) is not sufficient because it does not infer any structure, only membership.   Note that in this context navigational groupers are not considered to be concepts - they don't have a CodeSystem identifier.   SH: users would prefer to search than to navigate their way through a hierarchy to the item they want.  "Picklists" can be considered distinct from ValueSets (adding priority and other properties).  ML Usage in questionnaires.   "The way to do this is in the expansion"  DK Solution also available using Concept map translate given  'source' context, what likely values would be selected in a subsequent field. RH See also ValueSet Concept Order Extension. PWI "Tagging" may be preferred as it allows for multiple dimensions to be represented at the same time ML and also avoids codes appearing multiple times if they belong to more than one group. SH Would like to see standard for wider sharing of resources like reusable UI elements, and avoid overloading FHIR (separation of concerns).  SS Much harder to add semantics to existing data, than it is to enforce the semantics at the point of data capture.

TODO Elicit use cases from Rutt Lindström 

Condition vs Observation - care plan based on symptom.

Other CodeSystems which reference SNOMED CT

Marie-Alexandra Lambot Daniel Karlsson 

See https://build.fhir.org/ig/hl7-eu/laboratory/branches/master/index.html

https://github.com/hl7-eu/laboratory

https://confluence.hl7.org/display/HEU/Laboratory+Report+Implementation+Guide%2C+Edition+1

Requirements for making a Terminology Server compatible with IG Tooling

See Zulip discussion here:  https://chat.fhir.org/#narrow/stream/179202-terminology/topic/Terminology.20server.20requirements.20for.20IG.20builds.2E.2E.2E

2023-07-25

• Michael Lawley is implementing the requirements in Ontoserver
• Graeme is preparing the Terminology Server registry, probably a JSON document, that would make available different terminology servers, listing the capabilities, including which code systems on each server

2023-08-22

• Michael Lawley the scope has expanded, advancing on the implementation. The registry will document which terminology server meet requirements, it is a centralized resource, maintained by HL7. There is document that describes this. An implementation guide developer would use this information to choose a compatible terminology server as the backend of the IG valuesets. There is a test suite that servers can apply to demonstrate compatibility, Graeme will be the curator of the list, the submission process for a new server is under development.

2023-10-03 ML Ontoserver still a work in progress in this area.

2023-10-22 ML Ontoserver progressing to be trialed during NZ Connectathon in this context.

• Test suite is here: https://github.com/FHIR/fhir-test-cases.git
• They are executed via the valiadtion-cli, something like:
  java -jar org.hl7.fhir.validation.cli-6.1.3-SNAPSHOT.jar -txTests -tx https://r4.ontoserver.csiro.au/fhir

Question on the Observables Model - was discussed in both the MAG and the EAG.   Yongsheng Gao currently looking at proposals and next discussion will be at all staff meeting in June.

There was an inconsistent role grouping pattern in the observables, and the question was trying to find the reason for this. This is being evaluated.

Peter G. Williams There is a decision to move to the grouped pattern

Andrew Perry looking for opportunities to contribute to the observables and LOINC modeling decisions

2023-09-19 Update:  Direction of travel here suggests moving to have all attributes in a single role group, but preparatory hierarchy movements will be required first - Evaluation Procedures moving to Observables.  Discussion expected at October MAG meeting, followed by a briefing note if no major objections raised.   AP UK have concerns about problems caused with existing counterparts between the two subhierarchies.  UK did respond to RFC last week.

2023-10-03 SI responding to briefing note feedback (including encouragement from UK to engage as a matter of priority).  Discussion expected in both MAG and EAG at October Business Meetings. Two Schools of Thought:  LOINC style single observable hierarchy (order / result) vs. procedure + observable pairs for expressing ordering and results.

2023-10-22 AP <copy from 15:43>

Michael Lawley 

Daniel Karlsson 

Concept maps and SNOMED Maps  - how to materialize as both R4 and R5.

Metadata needed:  target CodeSystem URI,  source and target ValueSets.

Do we assume that a simple map is an equivalence.

For complex maps, how are the additional fields represented?   Eg in property, dependsOn and product (these are typed).   See 5.2.3.3 Complex and Extended Map from SNOMED CT Reference Sets  

Update 2023-06-13 Now working in confluence Concept Map in R5

2023-07-11 Work being done (ML) around clarity and specification for the parameters used in implicit Concept Maps.

2023-07-25 Michael Lawley and Dion had a discussion on metadata and put together a proposal of a JSON based metadata, presumably to be presented to the MAG (clarified 2023-10-03)

• Peter G. Williams Add to FHIR Agenda for April meeting and floating topic for MAG also.

2024-02-14 DK Enquired on status here.  KK has coded some support in R4 but uses comma delimited messaging.   ML Using extension to allow properties in R4 (fully available in R5).  See extension:  http://hl7.org/fhir/5.0/StructureDefinition/extension-ConceptMap.group.element.target.property

See example 1 and example 2 shows multiple groups matching.

Demos showing machine processing of ICD-10 rules:

https://github.com/IHTSDO/snomed-to-icd-10-mapper

https://ihtsdo.github.io/iid-icd-maps/

Discussion on whether or not the Terminology Server should have responsibility for applying the values to the rules to fully identify the correct target of the $translate operation. DK would like to see choice for client to calculate the rules.

Marie-Alexandra Lambot 

Michael Lawley 

Kai Kewley 

BCP-47 requires a dash every 8 digits so SCTIDs need to be broken up to be compliant.

Also the "x-sctlang" is required. 

Also discussed GG's request to Kai Kewley in the behaviour around language headers and how they interact with the displayLanguage in the HTTP GET request.

Rob Hausam 

Daniel Karlsson 

See Tuesday meeting item #6

Changes for R5  and check on use of dialect in x form in ECL Specification Appendix C:  Appendix C - Dialect Aliases

Note that where a language reference set pulls from more than one language, the BCP-47  tag could potentially missing out the <lang> element and start directly with "x-".  Options for referring to multiple languages: could be done either with a * (see https://developer.mozilla.org/en-US/docs/Web/HTTP/Headers/Accept-Language#syntax ) or with a comma separated list to indicate a priority order (although this isn't supported by the FHIR parameter (unless the server went out of it's way to allow for this), or use the accept-language header).  Use case is in the displayLanguage input parameter to a ValueSet $expand operation

• Peter G. Williams This extra detail should be filled into FHIR-languages to avoid overloading/over complicating the HL7 page.

2022-08-31 ML CSIRO attempting to get R5 compliant Ontoserver ready in time for HL7 Connectathon.

2022-10-04 With this page moving to terminology.hl7.org it is no longer subject to the ballot process.  Instead a "TSMG" ticket should be created.  Daniel Karlsson and Rob Hausam will progress this. 

• Rob Hausam 

Also tracking R5 changes to concept map - see http://build.fhir.org/valueset-concept-map-relationship.html.   Peter G. Williams to check SI intention for R5 compliance.

2022-10-18 DK EHealth Working Group on Semantics - discussion on cross border infrastructure based on CDA.  Suggestion that it could move to FHIR for new specifications/developments eg Lab Reports.

2022-11-02 RH Rob will check the status and how we can help it move

2023-02-07 RH R5 Ballot is complete.   Deadline to complete resolutions is Feb 24th.   Expectation to publish late April / early May.

2023-03-07: RH R5 going through QA currently. Some last-minute changes in ConceptMap: RH change in relationship types, new ValueSet to remove ambiguity. Directions of maps (very) explicit. No-map situation simplification. Element name changes. Choice datatypes in more places. ML property, dependsOn and product clarification. E.g. property is used in implicit ConceptMaps based on SNOMED complex maps. http://hl7.org/fhir/5.0.0-draft-final/conceptmap.html 

2023-07-11 ML Added UP ticket - https://jira.hl7.org/browse/UP-436 (Unified Terminology Governance Project)

Mechanisms for working with Languages

Designation extension

24 August DK Added pull request to Snowstorm  here

Implementation by ML using existing fields and specifying LangRefset in displayLanguage parameter with "preferredForLanguage" code and wildcard  Eg https://r4.ontoserver.csiro.au/fhir/ValueSet/$expand?displayLanguage=*-x-sctlang-20581000-087109&_format=json&url=http://snomed.info/sct/20611000087101?fhir_vs=ecl/160303001&includeDesignations=true

Oct 5 Release of Ontoserver 6.5.0 which includes support for language reference sets as above.

• Peter G. Williamsdocument examples using live Snowstorm instance

Next Steps: How to promote - could we present at a Vocab call?   (1530 ET Thursdays - may clash with SI Languages call)

8 Feb 2022 DK added Designation Extension into the SNOMED on FHIR IG see http://build.fhir.org/ig/IHTSDO/snomed-ig/StructureDefinition-designation-use-context.html

Kai Kewley 

MRCM is needed for writing good ECL and also for writing 'good' Post coordinated expressions.

Going forward:  suggestion that PJ and RH expose both the MRCM and the capabilities of ECL 2.0 with the wider HL7 and FHIR Communities.  See slides on ECL 2.0 here.  ML more generally this is a refinement axis which is represented as two things - the attribute and the range of values that that attribute can take.

• Peter G. Williams make a note of this in the IG

2022-11-1 ECL 2.0 can retrieve MRCM refsets content, the question is how to return them as FHIR resources (structure map?)

Using implicit concept maps may be an option to add operations such as get acceptable attributes or get range

(note SNOMED is the only CodeSystem that uses implicit concept maps, wording around that is changing, see https://jira.hl7.org/browse/FHIR-39266 )

• Alejandro Lopez Osornio and Kai Kewley will draft a demo.

Peter G. Williams

Implementation Guide for using SNOMED CT with FHIR.

IG Documentation: http://build.fhir.org/ig/FHIR/ig-guidance/index.html

Also look at the sample IG https://github.com/fhir/sample-ig see build http://build.fhir.org/ig/FHIR/sample-ig/

• Rob Hausam to speak to Lloyd about extending the base template as per http://build.fhir.org/ig/FHIR/ig-guidance/template.html Update 24 March: Documentation on this is "TODO"
• Peter G. Williams FHIR core content to be copied over to Snowstorm instance.

TODOS 

• Check build issues http://build.fhir.org/ig/IHTSDO/snomed-ig/qa.html    Update 2022-06-20 Tooling currently giving a null pointer, see https://build.fhir.org/ig/IHTSDO/snomed-ig/failure/build.log  asked question in Zulip  See https://chat.fhir.org/#narrow/stream/179252-IG-creation/topic/Null.20pointer.20in.20ValueSetRenderer   
• Note page to manually execute build through HL7 Tooling: https://fhir.github.io/auto-ig-builder/builds.html
• Rerun locally with latest tooling (also sushi)
• Run with local snowstorm provided as Tx
• See Mark Kramer presentation   https://www.youtube.com/watch?v=OmcSuAMf20s  Also https://fshschool.org/ 
• CONTENT! 
• Merge in DUC branch (Designation Use Context) with a view to implementing in a branch of Snowstorm and making available via connectathon.ihtsdotools.org
• Clean up other branches
• Check templates are up to date - should now be self updating, see https://github.com/FHIR/sample-ig (fsh may ask to update this structure).   Sushi sending out information about new format (PJ says leading whitespace is now significant).
• ReadMe should provide links for Publisher tooling
• Add discussion on Refset / IN (see above)
• Provide link to it in http://build.fhir.org/snomedct.html and discuss further socializing.
• TerminologyCapabilities caching is overly aggressive.
• Added 2022-08-23 Discuss ownership, hosting and copyright (joint copyright with HL7).  Source will be hosted in GitHub, pull requests will be welcome with this group acting as gatekeepers (reviewers) for that?   Suzy Roy would the wording of our original collaboration be helpful here?

2022-11-1: No news, check in the next call.

2022-11-15  Suggestion to set page per meeting list to work through.  Setting up one or two HTML style pages that could then be copied and modified and then use meetings to tackle more difficult content and review.  Finding best publishing location, cross referenced between https://terminology.hl7.org/SNOMEDCT.html

Pairings - Kai, Peter, Marie, Daniel, Rob

Top Topics

• What are the various Resources in terms of how they relate to SNOMED CT (Link to Follow the yellow brick code presentation).  
• ECL in FHIR (intensional ValueSets being less brittle)
• Languages
• Terminology Binding (General Approaches)
• IPS (GPS)
• FAQs eg how to recover historical assertions using Map
• Post Coordination & Transformation
• Relevant changes in R5 eg Concept Map (correlation changes)

2022-11-29

Example markdown page that could be copied and modified:  https://github.com/IHTSDO/snomed-ig/blob/master/input/pagecontent/sct_specific_behaviours.md

Work to be presented for 13 December (payment will be made in Glory^tm)

Peter & Kai - ECL in FHIR  (Update:   Used https://hackmd.io/  for collaborative markdown editing. )

Daniel & Marie - Allergy & Intolerance : (Update: Menu item added for extensions, confirmed examples are useful and appropriate for the Allergy Guide. )

Rob - IPS

• Peter G. Williams contact Ole Vage & Feijke re Translation Group and contributing to IG relating to use of languages in FHIR (complete 2023-10-16)

2022-12-13 ECL Page reviewed - MarkDown not displaying the same as it did the IDE, revisit.

Looking for some more structure that could be applied to the apparently unordered list of ValueSets (which is machine generated).  Any documentation on how to do that would be appreciated.   Other IG's we could compare to are : https://build.fhir.org/ig/HL7/US-Core/terminology.html & http://build.fhir.org/ig/HL7/fhir-ips/  ( also http://build.fhir.org/ig/HL7/fhir-ips/terminology.html )

2023-02-07 MAL work for Allergy Implementation Guide (which the SNOMED IG will link to) see SNOMED CT Clinical Implementation Guide for Allergy, Hypersensitivity and Intolerance

2023-02-21 DK Work done for languages - https://build.fhir.org/ig/danka74/snomed-ig/branches/languages/  Discussion about overloading of parameter for both display language and search language.   Checking behaviour around fall-back on displayed terms (eg context specific → national language → English).   For example, display parameter being a comma separated list (which has a defined order, unlike repeating the same parameter multiple times (also not allowed in the spec)).

2023-10-16 PWI Update:  We had a note to follow up on https://www.hl7.org/fhir/R4/valueset-animal-breeds.html as these have mostly been inactivated and moved to the Veterinary Extension.   In following up, it was determind that this valueset is no longer present in the FHIR core as of R5.

Discussion on * version wildcard. (relates to a Zulip discussion on expanding a ValueSet against multiple editions to give a superset?)  DK How could we specify the latest version of multiple modules.   Answer http://snomed.info/sct/*   (ie not specifying the version) or http://snomed.info/sct/*/version/*  to include concepts from previous versions.

For use in the module / version URI.   Existing workaround is to use multiple include elements for each version.

7 Sept ML Sticking point - what do we do with incompatible properties eg active/inactive between two different versions - the most recent?

Use case: primarily being able to validate codes that might exist in different editions.   Secondarily, being able to validate code received in a historical record ie where codes were valid at time of data entry.

25 Jan 2022: Snowstorm will already look across all Editions loaded when a codesystem version is not specified, eg:  https://browser.ihtsdotools.org/fhir/CodeSystem/$validate-code?coding=http://snomed.info/sct|443971000124108 only exists in the US Edition.  (See also the History proposals for ECL)

• Peter G. Williamsdocument Snowstorm multi-edition validation in IG

2022-05-17 ML Ontoserver supports ValueSets that draw from more than one version, so you could use that to compute the difference between one version and another.

2022-11-1: DK: Snowstorm does not yet support multiple include elements in different versions for the SNOMED code system. ML: The semantic is not yet clear, how to decide in which versions you check properties, parents, etc. Run separately for all inclusions and join the results. May need to understand better the use cases.

Michael Chu - let's discuss.

2023-10-03 ML working on registration of congenital abnormalities - is there a way to group disorders (eg as part of a syndrome), specifically in the Condition Resource to (See Condition Related Extension in R4 http://hl7.org/fhir/R4B/extension-condition-related.html / http://hl7.org/fhir/extensions/StructureDefinition-condition-related.html )   See https://hl7.org/fhir/extensions/extension-registry.html  also condition-dueto.  JC Syndrome is just a grouper name, it doesn't "cause" the manifestations as such.

2024-03-13 RC Querying on patient data using below / isa - how is that negotiated between a data server and a terminology server (or do they need to be one and the same?)

Peter Jordan

Michael Lawley

Impact of proposed changes (eg text searching in ECL) on FHIR. Questions around which language reference sets to use when there are multiple, especially partial/overriding context (referred to MAG for discussion)

8 Sept The FHIR specification does not specify a particular version of ECL, so we assume the latest.  Any enhancements added to ECL will be immediately relevant and available in FHIR.   Note that these latest additions while targeting descriptions are a concept filter, so display options (language etc) will affect the output of those concepts.   How about the filter parameter though, especially since ECL wo (ld allow multiple filters in multiple/different languages.

• Michael Lawley Suggested ticket: Parent and Child properties to (optionally?) support the Coding type.

This has now been implemented as text filters in ECL.   Archive discussion.

Daniel Karlsson

Peter G. Williams

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://snomed.info/sct&code=12345678&_elements=version

• Peter G. Williams Ticket implementing this lookup. Note that this could be implemented more generally for lookups of http://snomed.info/id/<SCTID> where the SCTID exists in an extension. Done - see STORM-262.

Peter G. Williams

CodeSystem "class vs instance" in url parameter between CodeSystem and ValueSet operations.

CodeSystem is understood.

In Valueset, url is the ValueSet url for example url = http://snomed.info/sct?fhir_vs= allows for the version URI to be used as stated in https://build.fhir.org/snomedct.html The base URL is either http://snomed.info/sct , or the URI for the edition version, in the format specified by SNOMED International in the SNOMED CT URI Specification.

The ValueSet version valueSetVersion is just some string identifier eg a timestamp or 0.1.0

Rob Hausam

What properties are returned?

Discussion: Both Ontoserver and Snowstorm are returning EffectiveTime which is not listed here (unlike other SNOMED specifics): https://build.fhir.org/snomedct.html

• Peter Jordan to raise a Jira ticket to ask for this to be returned - completed https://jira.hl7.org/browse/FHIR-26555

Point of interest: Grahame's server returns a copyright property.

Update 7 April - Question about whether this is required / desirable?

Michael Lawley

Terminology Capabilities: Default SNOMED Edition for a Server. Suggestion to invite Graham for a wider discussion. Resource is still at maturity 0.

11 August The resource is based on instances of code systems. Difficult to make statements about code systems generally, or specific SNOMED editions, etc. Will start a Zulip discussion on this. Michael Lawley Then potentially invite Grahame for a future discussion?

25 August It has been agreed that this resource will now have maturity level 1

See https://chat.fhir.org/#narrow/stream/179202-terminology/topic/tx.2Efhir.2Eorg.20New.20parameters.20for.20.24expand.20.26.20.24validate-code

8 Sept 20 Is there a Jira ticket ?   Rob says Grahame implemented this.

12 Jan:  RH update made to GG Server.   Documentation (assuming required) still outstanding.

Michael Lawley

Use case for fall back lookup when server does not know the answer to any particular question eg a façade server which has knowledge of all services it could potentially delegate to.

Aug 25: New capabilities in HAPI to allow delegation to an external terminology server.