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Submitting WG/Project/Implementer Group

  • Vocabulary

Justification and Objectives

The FHIR specification includes support for the provision of a terminology service - that is, a service that lets healthcare applications make use of codes and value sets without having to become experts in the fine details of the value sets and underlying code systems and their related resources. The management and proper use of terminology is fundamental to effective, interoperable data exchange, so this is an important capability to provide and test in the Connectathons.  We expect and hope to achieve: (1) improved capabilities of terminology servers measured by testing performance, (2) improved and more extensive terminology service testing, (3) implementation and implementer experience with aspects of the terminology services specifications, including experience with newer and previously lesser used terminology service operations and operation capabilities, (4) identify potential improvements as well as deficiencies and possibly errors in the FHIR terminology service specifications based on implementation and testing experience, and (5) increased awareness and utilization of terminology services by other Connectathon tracks.

David Hay's blog post on Terminology Services

This track will use the STU3, R4 and R5 Connectathon build versions of FHIR.

Clinical input requested (if any)

No specific needs identified for this at present.  We do have leadership and regular participants in the track who have backgrounds with significant clinical experience.

Related tracks

Every Connectathon track (or nearly so) needs terminology services!  We intend to focus much of our effort for this Connectathon on providing support for SNOMED CT (the most complex general clinical terminology) for the other Connectathon tracks (see Scenario 2 description below).

Proposed Track Lead

Rob Hausam, rrhausam@gmail.com

Peter Jordan, pkjordan@xtra.co.nz

Expected participants

Some or all of the following:

Track Orientation and Administration

We will consider hosting a new webinar to share further participation information about this track (especially if we identify a likelihood of a significant number of new participants).  The prior track orientation webinar materials (January 2018 WGM - New Orleans) are here:

Also consider joining and participating in the SNOMED on FHIR project Terminology Services (TS) calls here.

Connectathon Management Tool: ConMan: WGM Atlanta Sept 2019 (to be updated for Sydney Feb 2020)

Messaging & Communications: Zulip Connectathon Management Terminology Services Chat Stream

Test Support: Richard Ettema

Prerequisites

For all levels of testing the required pre-requisite is the fundamental requirement that all FHIR servers SHALL support the capabilities interaction.

The FHIR Terminology Servers under test are expected to have already downloaded and installed the required resources (Code Systems, Value Sets & Concept Maps).

System Roles

FHIR Terminology Server

For service providers, implement the following operations from http://hl7.org/fhir/terminology-service.html:

Support additional capabilities:

Service providers are not required to implement all of this functionality - it's a lot to do. For new implementers, start at the top and work down (generally).

FHIR Terminology Client Consumer

Implement any one or more of:

  • Do a value set expansion of one of the value sets in the spec
  • Validate a code using the spec against a FHIR value set, a v2 value set, LOINC or SNOMED CT
  • Validate a code using the spec against a code system such as LOINC or SNOMED CT
  • Look up a display for a code (most appropriate for v2/FHIR conversion)
  • Translate a code from one value set to another, based on the existing value set and ConceptMap resources, and/or other additional knowledge available to the server
  • Maintain a client-side closure table based on server-side terminological logic
  • References to SNOMED CT and LOINC implicit value sets
  • Create (POST, PUT) ValueSet resources referencing in-line and/or external code systems

At least one server supports all of these operations and capabilities (http://test.fhir.org/r4). Other servers (see the list above) will support several of these operations and capabilities.

Scenarios

1 - Introduction to Terminology

This has been and will remain a primary purpose of this track and provides a 'friendly introduction' for those new to Terminology Track in FHIR. Attendees participate in this track using a simple scenario that can be met with limited domain knowledge. It is quite feasible to complete the client side terminology interaction of the track within a day with only knowledge of a development environment and some previous FHIR knowledge (such as Patient). If creating a server, advanced preparation will be required.

Pre-connectathon testing is encouraged, but not required, where the participants can utilize the publicly available FHIR Terminology Servers listed above.

Testing and test reporting at the Connectathon event will be self-attested using ConMan and primarily involves peer-to-peer execution between known FHIR clients and/or servers.

2 - Terminology Services Support for SNOMED CT

In this scenario we will make a significant effort to reach out to the participants in the other Connectathon tracks to understand and provide support for their terminology service needs, focusing on  SNOMED CT (the most complex general clinical terminology).  This will include holding a breakout session on this topic early in the day on Saturday.  This scenario is in alignment with and supported by the work being done in the Terminology Services stream of the joint SNOMED on FHIR project of SNOMED International and HL7, including the implementation guide for SNOMED on FHIR that is being developed (as a FHIR IG). 

3 - ConceptMap Revisions

For FHIR R5 significant changes have been made to the ConceptMap resource, including:

  1. Replace the previous 'equivalence' element with a new 'relationship' element.
  2. Revise the concept-map-relationship (previously concept-map-equivalence) code system and value set so that the codes are easier and simpler to understand and choose and so that the mapping relationship direction is clearly specified.
  3. Related changes to the $translate and $closure operations based on the above code changes.  

Connectathon testing and implementation experience is needed to progress the revised ConceptMap resource through the maturity levels toward normative status.  

4 - $closure Operation

Connectathon testing and implementation experience is needed to progress the $closure operation through the maturity levels toward normative status.  This testing can be performed with the R4 or the revised R5 specification utilizing the new concept-map-relationship codes.  With the R5 version of $closure the client-side transitive closure table is expected to be based on a "narrower than" (or similarly named) relationship (rather than "subsumes" equivalence in R4). 

5 - Formal Testing of Terminology - Participants with FHIR experience

This scenario introduces a more formalized testing approach for those participants that have been working the FHIR Terminology specification and wish to move beyond basic testing and may have systems that are in active development, deployed or soon to be deployed into a production environment. Automated testing tooling is significantly leveraged for both automated terminology server testing (testing tool to FHIR terminology server) and surveillance of peer-to-peer testing (external FHIR client to external FHIR server).

Pre-connectathon testing is highly encouraged in order to be better prepared for the actual Connectathon event and to become familiar with the public testing platforms that will be used for the formal testing.

Testing and test reporting will be done using the public testing platforms which will provide test results via the new FHIR TestReport resource type as well as any specific reporting capabilities of those testing platforms. These reports will provide qualitative and quantitative analysis of the system under test and its conformance to the FHIR specification.

TestScript(s)

This track includes formal testing and reporting of test results utilizing a defined set of test scripts.
[Note:  The test scripts and repository location will be updated soon for the Sydney Connectathon 23.]

The TestScript and terminology content resources will be committed to the FHIR documents Github repository at: connectathons/AtlantaSep2019/FHIR3-0-1-Connectathon22/Terminology-Formal and connectathons/AtlantaSep2019/FHIR4-0-0-Connectathon22/Terminology-Formal. Please contact Grahame Grieve if you require commit privileges to this repository; otherwise, you may forward your TestScripts and related artifacts to Richard Ettema who will get them committed.

Additional Resources:

Available Test Script Sets

The test scripts listed below will be updated for Connectathon 23 and scripts for additional tests may be added.

Test Scripts - Supported Formats

  • JSON - TestScripts and fixtures are available under the JSON Format folder
  • XML - TestScripts and fixtures are available under the XML Format folder

Test Scripts - ValueSet Expand - $expand

  • connectathon-22-ts-expand - Terminology tests for $expand where the FHIR server is expected to have the existing ValueSet resources for extensional and intensional test cases.
  • connectathon-22-ts-expand-filter - Terminology tests for $expand with filter options where the FHIR server is expected to have the existing ValueSet resources for extensional and intensional test cases.
  • terminology-c22-expand-version-extensional1-01-ok (FHIR R4 Only) - $expand operation with a valid version parameter test for ValueSet extensional-case-1 where the expected outcome is a successful response.
  • terminology-c22-expand-version-extensional1-02-notok (FHIR R4 Only) - $expand operation with an invalid version parameter test for ValueSet extensional-case-1 where the expected outcome is a failure response with a returned OperationOutcome.

Test Scripts - CodeSystem Lookup - $lookup

  • connectathon-22-ts-lookup-loinc-01-ok-get-simple - CodeSystem $lookup simple tests against known LOINC codes where the expected outcome is a successful response with valid name and display value. All $lookup operations are performed using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-lookup-loinc-02-ok-post-code-simple - CodeSystem $lookup simple tests against known LOINC codes where the expected outcome is a successful response with valid name and display value. All $lookup operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system and code.
  • connectathon-22-ts-lookup-loinc-03-ok-post-coding-simple - CodeSystem $lookup simple tests against known LOINC codes where the expected outcome is a successful response with valid name and display value. All $lookup operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of coding.
  • connectathon-22-ts-lookup-sct-01-ok-get-simple - CodeSystem $lookup simple tests against known SNOMED codes where the expected outcome is a successful response with valid name and display value. All $lookup operations are performed using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-lookup-sct-02-ok-post-code-simple - CodeSystem $lookup simple tests against known SNOMED codes where the expected outcome is a successful response with valid name and display value. All $lookup operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system and code.
  • connectathon-22-ts-lookup-sct-03-ok-post-coding-simple - CodeSystem $lookup simple tests against known SNOMED codes where the expected outcome is a successful response with valid name and display value. All $lookup operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of coding.

Test Scripts - CodeSystem Subsumes - $subsumes

  • connectathon-22-ts-subsumes-snomed-01-ok-get - $subsumes tests against known SNOMED codes where the expected outcome is a successful response with a valid outcome code value. All $subsumes operations are performed using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-subsumes-snomed-02-ok-post-code - $subsumes tests against known SNOMED codes where the expected outcome is a successful response with a valid outcome code value. All $subsumes operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system, codeA and codeB.
  • connectathon-22-ts-subsumes-snomed-03-ok-post-coding - $subsumes tests against known SNOMED codes where the expected outcome is a successful response with a valid outcome code value. All $subsumes operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system, codingA and codingB.
  • connectathon-22-ts-subsumes-snomed-04-notok-get - $subsumes tests against known and unknown SNOMED codes where the expected outcome is a failure response with a returned OperationOutcome. All $subsumes operations are performed using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-subsumes-snomed-05-notok-post-code - $subsumes tests against known and unknown SNOMED codes where the expected outcome is a failure response with a returned OperationOutcome. All $subsumes operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system, codeA and codeB.
  • connectathon-22-ts-subsumes-snomed-06-notok-post-coding - $subsumes tests against known and unknown SNOMED codes where the expected outcome is a failure response with a returned OperationOutcome. All $subsumes operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system, codingA and codingB.

Test Scripts - CodeSystem Translate - $translate

  • connectathon-22-ts-translate-01-ok-get - $translate tests against known FHIR code systems where the expected outcome is a successful response with a matched code value from the target system. All $translate operations are performed using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-translate-02-ok-post-code - $translate tests against known FHIR code systems where the expected outcome is a successful response with a matched code value from the target system. All $translate operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system, codeA and codeB.
  • connectathon-22-ts-translate-03-ok-post-coding - $translate tests against known FHIR code systems where the expected outcome is a successful response with a matched code value from the target system. All $translate operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system, codingA and codingB.
  • connectathon-22-ts-translate-04-notok-get - $translate tests against known and unknown FHIR code systems where the expected outcome is a failure response with a returned OperationOutcome. All $translate operations are performed using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-translate-05-notok-post-code - $translate tests against known and unknown FHIR code systems where the expected outcome is a failure response with a returned OperationOutcome. All $translate operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system, codeA and codeB.
  • connectathon-22-ts-translate-06-notok-post-coding - $translate tests against known and unknown FHIR code systems where the expected outcome is a failure response with a returned OperationOutcome. All $translate operations are performed using the FHIR Operation Framework HTTP POST method with Parameters of system, codingA and codingB.

Test Scripts - CodeSystem Validate Code - $validate-code

  • connectathon-22-ts-validate-cs-loinc-01-ok-get - $validate-code tests against known LOINC codes where the expected outcome is a successful response using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-validate-cs-loinc-02-ok-post-code - $validate-code tests against known LOINC codes where the expected outcome is a successful response using the FHIR Operation Framework HTTP POST method with Parameters of url, code and display.
  • connectathon-22-ts-validate-cs-loinc-02-ok-post-coding - $validate-code tests against known LOINC codes where the expected outcome is a successful response using the FHIR Operation Framework HTTP POST method with Parameters of url and coding.
  • connectathon-22-ts-validate-cs-loinc-04-notok-get - $validate-code tests against known LOINC codes where the expected outcome is a failure response using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-validate-cs-loinc-05-notok-post-code - $validate-code tests against known LOINC codes where the expected outcome is a failure response using the FHIR Operation Framework HTTP POST method with Parameters of url, code and display.
  • connectathon-22-ts-validate-cs-loinc-06-notok-post-coding - $validate-code tests against known LOINC codes where the expected outcome is a failure response using the FHIR Operation Framework HTTP POST method with Parameters of url and coding.
  • connectathon-22-ts-validate-cs-sct-01-ok-get - $validate-code tests against known SNOMED-CT codes where the expected outcome is a successful response using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-validate-cs-sct-02-ok-post-code - $validate-code tests against known SNOMED-CT codes where the expected outcome is a successful response using the FHIR Operation Framework HTTP POST method with Parameters of url, code and display.
  • connectathon-22-ts-validate-cs-sct-02-ok-post-coding - $validate-code tests against known SNOMED-CT codes where the expected outcome is a successful response using the FHIR Operation Framework HTTP POST method with Parameters of url and coding.
  • connectathon-22-ts-validate-cs-sct-04-notok-get - $validate-code tests against known SNOMED-CT codes where the expected outcome is a failure response using the FHIR Operation Framework HTTP GET method.
  • connectathon-22-ts-validate-cs-sct-05-notok-post-code - $validate-code tests against known SNOMED-CT codes where the expected outcome is a failure response using the FHIR Operation Framework HTTP POST method with Parameters of url, code and display.
  • connectathon-22-ts-validate-cs-sct-06-notok-post-coding - $validate-code tests against known SNOMED-CT codes where the expected outcome is a failure response using the FHIR Operation Framework HTTP POST method with Parameters of url and coding.

Test Scripts - ValueSet Validate Code - $validate-code

  • connectathon-22-ts-validate-code - $validate-code tests where the FHIR Terminology server is expected to have the LOINC and SNOMED-CT code systems available.
  • connectathon-22-ts-validate-code-optional - $validate-code tests with optional invocations where the FHIR Terminology server is expected to have the LOINC and SNOMED-CT code systems available.


The AEGIS Touchstone testing tool has test scripts available for tracks to test their implementations. See www.touchstone.com to sign in our register if you are a new user.
Below, you will find a link to the tests specific to this HL7 track. Please send questions or issues to touchstone_support@aegis.net and a team member will be glad to assist you.

Terminology Tests for Connectathon 23 are found here:   Terminology Tests in Touchstone

Security and Privacy Considerations

Most FHIR terminology terminology service endpoints are open (at present).  This may change in the future as adoption and implementation experience increases in order to more directly manage external (non-HL7) terminology licensing considerations.  Some servers do allow or require authentication (e.g. Apelon - see above).

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