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  • Implementations of R4 should be strictly compatible with implementations of R4A with only explicit known, approved exceptions that are expected to have minimal implementer impact.
  • Tooling will only support a single 4.x release (i.e. once 4A is out, validation against 4.0.x will no longer be possible/necessary)
  • We can figure out a way to manage the versioning associated with the introduction of the new release that won't break the tooling infrastructure (e.g. IG Publishing)


  • No changes of any sort to normative content without FMG approval
  • No changes that would change the forward or backward interoperability of resources, data types, profiles or extensions with the exception of resources (including the introduction of new resources or data types) unless specifically approved by FMG
    • Proposed resources at the moment are Evidence Based Medicine (enumerate), Medication Regulation (enumerate) and Subscription
    • Specifically, no changes to cardinality, data types, bindings, element names, constraints, etc.
    • Adding 'best practice' constraints or warnings is acceptable?
  • Documentation changes that do not significantly change the meaning of elements or provide usage guidance are fine
  • No changes to conformance verbiage (SHALL/SHOULD/MAY) without FMG approval
  • Examples can be added, removed or modified
  • Profiles and extensions can be added
  • Profiles and extensions can be marked as 'deprecated' with FMG approval but not removed
    • Expectation is that there will be clear guidance provided as to the alternative.
  • New terminologies can be registered
  • FHIR terminologies that are not the target of required or extensible bindings can be modified
  • FHIR terminologies that ARE the target of required or extensible bindings can be modified substantively (adding or removing codes, changing relationships, significantly revising concept definitions) only with FMG approval
    • Approval will be contingent on an examination of the impact of the change on interoperability with existing/in-development implementations
  • Publication of terminology can be changed to cause UTG-managed terminologies to link to the UTG rendering rather than FHIR rendering
  • We will introduce the type regularization modifications (i.e. the definition of 'type', 'base', etc. from

Work groups are responsible for ensuring that relevant changes made to R4A are also reflected in the R5 draft

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