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FHIR Terminology 
Lloyd McKenzie 
FHIR Developer Days 
November 25, 2014 
© 2014 HL7 ® International. Licensed under Creat...
This presentation 
 Can be downloaded here: 
 http://www.slideshare.net/DevDays2014 
 Is licensed for use under the Cre...
Who am I? 
 Name: Lloyd McKenzie 
 Company: Gevity 
 Background: 
 One of FHIR’s 3 principle editors 
 Co-chair FHIR ...
Who are you? 
 Who is familiar with: 
 V2 
 V3 
 CDA 
 Background 
 Technical (e.g. developer, architect) 
 Clinica...
Tutorial Objectives 
 In next 1.5 hours 
 How is coded data shared in FHIR? 
 Understanding bindings and profiling voca...
SENDING CODED DATA 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered t...
The “code” data type 
 Just a code 
 Code system is fixed 
 Value set is fixed* 
 Display name is known 
 Used for “s...
What if I need a 
different “code”? 
 Code data elements aren’t extensible 
 Can’t send your own custom codes 
 If code...
Coding 
 Code + system 
 Not often used directly 
 If you need one coding, you 
probably need translations 
and/or orig...
URL vs. OID 
 In v2, you could identify code systems (and 
identifier systems) in a variety of ways 
 typically a local ...
CodeableConcept 
 All codings are “equal” 
 One can be “primary” 
 reflects “originally selected”, 
not “what my profil...
What to use in an 
extension? 
 Default is CodeableConcept – it’s safest for 
subsequent migration and interoperability 
...
Codes vs. Identifiers 
Coding 
 code 
 system 
 display (for code), 
version, primary, 
valueSet 
 Represents 
meaning...
Namespace resource 
 Defines both code systems 
and identifier types 
 Allows mapping between 
OIDs, URLs, etc. 
© 2014 ...
BINDINGS 
15 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered tradema...
Bindings 
 Bindings identify what sort of codes are 
allowed for a given element 
 Can be: 
 Value set 
 Defined set o...
Binding Conformance 
 required: You must use the specified codes 
 at least for concepts they apply to 
 preferred: You...
Binding Extensibility 
 Non-extensible: The set of codes is 
considered to be complete. Depending on 
conformance level, ...
Example 
 Value set: Red, Blue, Green 
19 
Binding Concept = Navy Concept = Orange 
required, non-extensible Must use Blu...
But those aren’t the 
terms in the ballot . . . 
Resource binding Binding 
Conformance 
Binding 
Extensibility 
Fixed requ...
Profiling vocabulary 
 Extensible -> Non-extensible 
 Example -> preferred -> required 
 Exclude codes from parent valu...
VALUE SETS 
22 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trade...
Value Set 
23 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered tradem...
Define example 
24 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered t...
Compose example 
25 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered ...
Expansion example 
26 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registere...
Code system vs. 
Value set 
 Code systems define symbols with specific 
meanings 
 E.g. LOINC, SNOMED, ICD-x, IETF langu...
SEARCH AND OTHER 
OPERATIONS 
28 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven ar...
Search parameters 
 Token 
 Exact match: system|code 
 gender=http://hl7.org/fhir/v3/AdministrativeGender|F 
 Code, an...
Search parameters 
 Modifiers 
 Display Coding.name or CodeableConcept.text: 
text 
 gender:text=female 
 Code in valu...
$expand 
 Takes in a value set and returns the value 
set containing the expansion as of “now” 
 http://....ValueSet/som...
$validate 
 Takes a code/Coding/CodeableConcept and 
checks if it’s valid against a value set 
 Specify value set same a...
$translate 
 Uses concept map to translate code 
 http://...ConceptMap/id$translate 
 code, Coding or CodeableConcept p...
FHIR Terminology 
Services 
 FHIR provides most of what’s needed for a 
fully functional terminology server 
 Create, up...
Semantic Web 
 Work is underway for a third FHIR syntax – 
RDF 
 As well, we’re looking at 
 Supporting conversion of P...
Questions? 
 http://hl7.org/fhir lmckenzie@gevity.com 
36 
© 2014 HL7 ® International. Licensed under Creative Commons. H...
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Terminology, value-sets, codesystems by Lloyd McKenzie Slide 1 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 2 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 3 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 4 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 5 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 6 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 7 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 8 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 9 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 10 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 11 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 12 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 13 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 14 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 15 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 16 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 17 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 18 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 19 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 20 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 21 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 22 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 23 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 24 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 25 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 26 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 27 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 28 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 29 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 30 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 31 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 32 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 33 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 34 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 35 Terminology, value-sets, codesystems by Lloyd McKenzie Slide 36
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Terminology, value-sets, codesystems by Lloyd McKenzie

Terminology, value-sets, codesystems by Lloyd McKenzie

  1. 1. FHIR Terminology Lloyd McKenzie FHIR Developer Days November 25, 2014 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  2. 2. This presentation  Can be downloaded here:  http://www.slideshare.net/DevDays2014  Is licensed for use under the Creative Commons, specifically:  Creative Commons Attribution 3.0 Unported License  (Do with it as you wish – just give credit) © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  3. 3. Who am I?  Name: Lloyd McKenzie  Company: Gevity  Background:  One of FHIR’s 3 principle editors  Co-chair FHIR Management Group  Co-chair HL7 Modeling & Methodology  Chair HL7 Canada Architecture & Infrastructure  Heavily involved in HL7 and healthcare exchange for last 15 years (v2, v3, CDA, etc.) 3 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  4. 4. Who are you?  Who is familiar with:  V2  V3  CDA  Background  Technical (e.g. developer, architect)  Clinical  Non-technical (e.g. manager, CEO) 4 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  5. 5. Tutorial Objectives  In next 1.5 hours  How is coded data shared in FHIR?  Understanding bindings and profiling vocabulary  Process to creating and use value sets  Future of FHIR terminology 5 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  6. 6. SENDING CODED DATA © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  7. 7. The “code” data type  Just a code  Code system is fixed  Value set is fixed*  Display name is known  Used for “structural” elements  Essential to fundamental interoperability  Reasonable to standardize at the international level  E.g. status, bundle.type, etc. 7 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  8. 8. What if I need a different “code”?  Code data elements aren’t extensible  Can’t send your own custom codes  If coded element is optional  Omit the element and just send an extension  If coded element is minOccurs=1  Choose the code closest matching your need  Send additional semantics as an extension  Consider submitting a change request for inclusion in a future version of FHIR 8 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  9. 9. Coding  Code + system  Not often used directly  If you need one coding, you probably need translations and/or original text -> CodeableConcept  Why is everything optional? 9 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  10. 10. URL vs. OID  In v2, you could identify code systems (and identifier systems) in a variety of ways  typically a local string  In v3 you had to use OIDs  E.g. 2.14.1237.937.25.58  In FHIR, we use URLs Human-readable Potentially resolvable No training required  E.g. http://myhospital.org/codes/labresults  Can also use urn:oid:2.14.1237.937.25.58  But why would you want to? 10 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  11. 11. CodeableConcept  All codings are “equal”  One can be “primary”  reflects “originally selected”, not “what my profile wants”  To maximize interoperability, send what codings you know  Text and coding.display are fallbacks for systems that don’t recognize your code  So good practice to include them 11 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  12. 12. What to use in an extension?  Default is CodeableConcept – it’s safest for subsequent migration and interoperability  Use coding only if translations don’t make sense (not just if you don’t currently have need)  Use code if  essential that everyone use the same codes  you can define a set of codes that cover the space 12 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  13. 13. Codes vs. Identifiers Coding  code  system  display (for code), version, primary, valueSet  Represents meaning/concept  Can cover real things such as countries, states Identifier  value  system  label (for system), use, period, assigner  Represents “identity”, but can identify a “kind” 13 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  14. 14. Namespace resource  Defines both code systems and identifier types  Allows mapping between OIDs, URLs, etc. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  15. 15. BINDINGS 15 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  16. 16. Bindings  Bindings identify what sort of codes are allowed for a given element  Can be:  Value set  Defined set of codes from 1..* code systems  Reference  E.g. Mime types  Description  E.g. Location type codes 16 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  17. 17. Binding Conformance  required: You must use the specified codes  at least for concepts they apply to  preferred: You SHOULD use the specified codes  But if you have a good reason, you can use something else instead  example: These codes just give an idea of what you might use  No expectation (or recommendation) of use 17 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  18. 18. Binding Extensibility  Non-extensible: The set of codes is considered to be complete. Depending on conformance level, you SHALL/SHOULD not use additional codes  Extensible: The set of codes is likely incomplete. You may use additional codes to convey concepts not represented in the bound set of codes 18 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  19. 19. Example  Value set: Red, Blue, Green 19 Binding Concept = Navy Concept = Orange required, non-extensible Must use Blue Not codeable required, extensible Must use Blue Can use Orange preferred, non-extensible Should use Blue, can use Navy Shouldn’t use Orange, but can preferred, extensible Should use Blue, can use Navy Can use Orange example, extensible Use whatever you like Use whatever you like © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  20. 20. But those aren’t the terms in the ballot . . . Resource binding Binding Conformance Binding Extensibility Fixed required Non-extensible Incomplete preferred Extensible Example example Extensible 20 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  21. 21. Profiling vocabulary  Extensible -> Non-extensible  Example -> preferred -> required  Exclude codes from parent value set  If parent was extensible, add codes to value set 21 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  22. 22. VALUE SETS 22 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  23. 23. Value Set 23 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  24. 24. Define example 24 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  25. 25. Compose example 25 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  26. 26. Expansion example 26 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  27. 27. Code system vs. Value set  Code systems define symbols with specific meanings  E.g. LOINC, SNOMED, ICD-x, IETF language codes, local lab result codes, etc.  Value sets define collections of codes for use in a particular context  E.g. Codes for vital signs, codes for procedures  Can come from multiple code systems or a single code system 27 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  28. 28. SEARCH AND OTHER OPERATIONS 28 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  29. 29. Search parameters  Token  Exact match: system|code  gender=http://hl7.org/fhir/v3/AdministrativeGender|F  Code, any system: code  gender=F  Code, no system: |code  gender=|F 29 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  30. 30. Search parameters  Modifiers  Display Coding.name or CodeableConcept.text: text  gender:text=female  Code in value set: in  Gender:in=http%3A%2F%2Fhl7.org%2Ffhir%2FVal ueSet%2Fsome-genders  Code on in value set: not-in  Gender:not-in= http%3A%2F%2Fhl7.org%2Ffhir%2FValueSet% 30 2Fsome-genders © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  31. 31. $expand  Takes in a value set and returns the value set containing the expansion as of “now”  http://....ValueSet/someId$expand  http://...ValueSet$expand?[someURL]  http://...ValueSet (pass ValueSet in body)  Additional parameters  filter: Only include concepts with display name containing string  date: Generate as of specified date 31 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  32. 32. $validate  Takes a code/Coding/CodeableConcept and checks if it’s valid against a value set  Specify value set same as for $expand  Code to validate  code+system, version, display  coding  codeableConcept  date – date to validate as-of  Outputs: true/false 32  message if not valid, display names if valid © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  33. 33. $translate  Uses concept map to translate code  http://...ConceptMap/id$translate  code, Coding or CodeableConcept passed as per: $validate  Output:  True if can be translated  Message if can’t be translated  Translated coding if it can be translated 33 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  34. 34. FHIR Terminology Services  FHIR provides most of what’s needed for a fully functional terminology server  Create, update, retrieve and search code systems, value sets and concept maps  including versions there-of  Determine value set expansions, validate codes and translate concepts  Additional guidance here:  http://hl7-fhir.github.io/terminology-service.html 34 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  35. 35. Semantic Web  Work is underway for a third FHIR syntax – RDF  As well, we’re looking at  Supporting conversion of Profiles to OWL  Expression of mappings in OWL and/or SPARQL  Adding additional semantic layers/mappings to allow support hierarchies (e.g. “order-related”, “medication-related”, etc.) 35 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  36. 36. Questions?  http://hl7.org/fhir lmckenzie@gevity.com 36 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
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