Introduction

Custodians of standardized terminologies have developed rich semantic frameworks that can be used to interact with individual concepts in an elegant fashion, utilizing the relationships between terms to dynamically adjust user interfaces or derive clinical patterns. Today, these frameworks are distributed via proprietary formats and are tailored to the specific source terminology. As a result, any system looking to utilize the full semantic power of the terminology must build customized data pipelines to process those formats.

This Implementation Guide (IG) provides profiles and implementation guidance on utilizing the CodeSystem resource for exchanging terminology change sets that include full semantic detail from the source terminology. It also addresses exchanging terminology change sets containing provisional concepts not yet incorporated in source terminologies, such as those requiring rapid distribution during a pandemic-response context. Analysis of semantic detail to include in a change set is informed by the Tinkar Standardized Terminology Knowledgebase Reference Model, and mappings from that architecture are included on CodeSystem profiles.

Technical Overview

The design for Terminology Change Sets is primarily a robust utilization of the CodeSystem resource's modelling for CodeSystem.concept and CodeSystem.property to convey not just the concept identifiers and descriptions, but the full semantic design for each concept. Additionally, a Provenance instance is used to provide insight into the creation of the Terminology Change Set, particularly using Provenance.what to reference the baseline Terminology from which the Change Set was derived.

The main sections of this IG are:

• Guidance - this page provides best practices and considerations for implementation of Terminology Change Sets.
• Background - these pages provide background on how incremental releases of Terminologies are currently handled, the need for a standardized Terminology Change Set format in FHIR, and an inventory of known FHIR limitations related to the inclusion of full semantic detail for terminology concepts.
• FHIR Artifacts - this page provides the central source for all Profiles, Extensions, ValueSets, and Examples used in this IG.
• Tinkar Reference Model - these pages provide context and background for the Tinkar Reference Model, which informed the analysis and design for Terminology Change Set profiles.
• Downloads - this page provides links to downloadable artifacts.
• Change Log - this page documents the changes across the versions of the Terminology Change Set IG.

Credits

This implementation guide was made possible by the thoughtful contributions of the following people and organizations:

• Keith Campbell MD PhD, US Food and Drug Administration (FDA)
• Marti Velezis, Sonrisa Consulting
• Russell Ott, Deloitte Consulting LLP
• Raja Cholan, Deloitte Consulting LLP
• Matthew Deitz, Deloitte Consulting LLP
• Bimla Siwakoti, Deloitte Consulting LLP
• Jess Bota, Apelon
• Andrea Pitkus PhD MLS(ASCP)^CM FAMIA, University of Wisconsin School of Medicine and Public Health
• Carol Macumber, Clinical Architecture

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.uv.termchangeset.r4) and R4B (hl7.fhir.uv.termchangeset.r4b) are available.

Dependency Table

Package hl7.fhir.uv.extensions.r4#5.1.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Globals Statements

There are no Global profiles defined

IP Statements

This publication includes IP covered under the following statements.

• This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  • LOINC: LOINC_277_Attachments_ChangeSet
• This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  • SNOMED Clinical Terms® (SNOMED CT®): CaseSignificanceVS, DefiningRelationshipType... Show 9 more, DefiningRelationshipTypeVS, DescriptionAcceptabilityVS, DescriptionDialect, DialectVS, ELProfileSetOperatorVS, ElProfileSetOperator, SNOMEDCT_413839001_ChronicLungDisease_ChangeSet_46dc8ea230544ceba51145f774fe9fdd, SNOMEDDescriptionAcceptability and SNOMEDDescriptionsCaseSensitivity
• This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  • Provenance participant type: Provenance/053f26d4-b805-4ff2-8c42-866459d5f1f4, Provenance/52b1a1d2-80ab-460b-b5fc-341edd35b032 and Provenance/7e4f317e-8c13-46ba-b79a-9913da2afa2c
• This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  • ActReason: Provenance/053f26d4-b805-4ff2-8c42-866459d5f1f4, Provenance/52b1a1d2-80ab-460b-b5fc-341edd35b032 and Provenance/7e4f317e-8c13-46ba-b79a-9913da2afa2c
  • DataOperation: Provenance/053f26d4-b805-4ff2-8c42-866459d5f1f4, Provenance/52b1a1d2-80ab-460b-b5fc-341edd35b032 and Provenance/7e4f317e-8c13-46ba-b79a-9913da2afa2c