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Date 10:00 UTC on Wednesday 19 January 2022 - 90 minutes.   

Objectives

  • FHIR Terminology Services and Resources discussion
  • FHIR Terminology Binding discussion

Discussion items

ItemDescription

Mins

OwnerNotes & Actions
1Welcome and introductions2

Recording, notes & attendance.


2Previous Meetings2
3Round Table Introductions20ALL

India NRC - Manisha MantriSayali Pophalkar Gaurav Vaishnav Using SNOMED with LOINC and ICD-10.  FHIR recommended nationally as a standard.   Looking to build FHIR compliant TS at National Level, especially for lookup and validate & expand.

Australia - N/A

Belgium - Marie-Alexandra Lambot Anne Nerenhausen  multi-discipline data exchange programme for care-sets, FHIR objects codified in SNOMED CT (firstly allergy intollerance)

Estonia - Rutt Lindström switching to FHIR Nationally, preferring international terminologies.  No National TS yet, currently capturing requirements.

Hong Kong - Karissa Hung Maggie LauHave own terminology table, mapped to other terminologies including SNOMED CT.  Looking to learn more about using 

Netherlands - Pim Volkert

Norway - Oskar Hurtig

New Zealand - Peter Jordan (HL7)  National Terminology Server for NZ currently under development.  Peter's own implementation "Terminz".   FHIR Release 5 underway eg changes to Concept Map.

Sweden - Daniel KarlssonNo clear decision made yet on using FHIR with SNOMED but there are a number of projects underway eg with HL7 Sweden.  Some competition in this space for Terminologies but 

United Kingdom - Andrew Perry(NHS) Various FHIR profiles in use for moving data between primary and secondary care incorporating SNOMED.   National Terminology Server procured (not publicly available - constrained by copyright eg non UK access).  Programme of implementations which use the National Server underway.  See https://digital.nhs.uk/services/terminology-servers

SNOMED International - Linda Bird Alejandro Lopez Osornio Kai Kewley Peter G. Williams

4Known FHIR Implementations /  National Terminology Servers10

FHIR ValueSet $expand Comparison Tool

National Terminology Servers: United Kingdom,  Netherlands, Norway

Snowstorm


5Other Meetings10

Recent events:

HL7 Jan 2022 Virtual meeting: Aim for testing ConceptMap on the Connectathon (Jan 10-12). Set up an independent Connectathon after the Jan meeting?  HL7 May 2022 Dallas   

Upcoming events:

10:00 UTC from Wednesday 19 January 2022 every 4 weeks (the "off" week from this call). TB & TS.

PJ 24 Aug  No Nov Dev Days 2021.   Next will be US Edition in June 2022 (Cleveland)

New HL7 Group TSMG (meeting Wed PM ET every other week) - Terminology Service Management Group (HTA Thursday AM is now a subgroup of the TSMG)

GDHP - Global Digital Health Partnership Jan 26 Mini Connectathon (IPS focus)

6India specific situation and direction20
  • The overview of the usage of FHIR & other codes systems in India (For eg: SNOMED CT, LOINC, ICD) & overview of ‘Ayushman Bharat Digital Mission (ABDM)’
  • The need for a terminology server supporting all the codes systems, country-specific extensions & refset, hosted for large users (or for the country)
7SNOMED CT guidance around Allergy and Hypersensitivity

20

Asked group for review of FHIR specific elements in "

Implementation Guide for Use of SNOMED CT in Documentation of Allergy, Non-allergic Hypersensitivity and Intolerance" 

8Definition of GPS
Rob Hausam

Request that SI make the GPS ValueSet available as an extensional definition.

SI are (I think - PWI) in agreement to do this.

  • Peter G. Williamsticket and progress.   MAINT-1740 Target October 15 into production (need SearchAfter functionality for Refset Members).   Also check date for next GPS publication.

16 Nov Update:   "Search After" functionality will be available in Prod 1 Dec.

9Topics for Terminology Binding Stream

Collecting topics for TB stream here, with a view to having a call when there's sufficient material

FamilyMemberHistory - how is "no family history of X" best represented?

FreshDesk ticket question on Allergy substance cross field validation.  DK: Mappings to other information models, is that helpful?

20 April:   Topic for discussion - new Resources introduced in R4B.    Also (Linn Brandt) Use case: Registries need nullFlavor-concepts in their value sets. Which code system to use?  Consider "Long COVID no longer present" as a topical example.  4 May DK: This is more of a negation issue than null flavour, also probability.   JL Distinction between unknown and uncertain.

Oct 5 Request for input from nutrition CRG.

10Language Reference Sets in FHIR
All

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.

11SNOMED FHIR Implementation Guide

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/

TODOS 

  • Check build issues http://build.fhir.org/ig/IHTSDO/snomed-ig/qa.html
  • Rerun with latest tooling (also sushi)
  • Run with local snowstorm provided as Tx
  • See Mark Kramer presentation 
  • CONTENT!  (PWI speak to PTB)
  • 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.
12

Expanding ValueSets across multiple Editions.



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.

13Long Term Home for Terminology Information

Rob Hausam (primarily Vocab WG)

Long Term Home for Terminology Information that can be maintained independently of FHIR versions.

See https://chat.fhir.org/#narrow/stream/179202-terminology/topic/Why.20does.20the.20spec.20contain.20a.20SNOMED.20CodeSystem.20resource.3F

7 Sept Relates to problematic page https://www.hl7.org/fhir/r4/codesystem-snomedct.html   PWI discuss internally - done.

Update 21 September - General agreement that that page can be removed.  Is out of date and not serving useful purpose.

14Any Other Business

Next time:   




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See also FHIR Terminology Services Discussions

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