This page summarizes the implementation of an Expression Extension using the HL7 FHIR Terminology Services API. This approach is in the process of being implemented and supported by the Snowstorm FH
Under development
This section is still under active development, and the API examples will change as reference implementations mature and this is discussed with the community of practic
To represent an expression repository using FHIR terminology services, the required solution will depend on what approach is taken to uniquely refer to the expressions:
The expressions themselves may be used as an identifier
With this approach, a CodeSystem Supplement will be created and function as the expression repository
This supplements the applied SNOMED CT CodeSystem
A separate identifier is created for each expression
With this approach, the following FHIR are required
a to function as the expression repository
With this implementation, the defined operations for CodeSystems and ConceptMaps can be utilized to support the services required for an expression repository. Please refer to the HL7 FHIR documentation for further details:
CodeSystem
Creating an expression repository using a FHIR Terminology Server involves the creation of the following structures:
A (expRep): This functions as the actual expression repository and is used to hold the expressions
A (expId): This code system is used to hold the unique expression identifiers
A : This is used to map between the expressions in the expRep CodeSystem supplement and the expId CodeSystem. The ConceptMap enables the translation of expressions to (and from) shorter codes for systems with restricted code lengths
(Source: )
Use an implicit value set with ECL.
A display term should be returned in the response of the lookup operation. The display term may be generated in a very simple way by just concatenating.
This should happen when the expression is inserted into the code system.
This should happen when the expression is inserted into the code system.
a to hold the expression identifiers
a to hold the association between the expression identifiers and the expressions
ConceptMap
Create Code System Supplement
POST /CodeSystem
Create the CodeSystem supplement.
This operation must specify a version URI that uses the snomed.info xsct URI with a specific module but no version.
This resource must supplement a specific version of a SNOMED CT edition.
The example supplements the International Edition of SNOMED CT (900000000000207008), version Jan 2023 (20230131).
{
Create SNOMED Exp IDs Code System
POST /CodeSystem
(Only needed if EHR cannot store expressions)
If needed, create a CodeSystem for expression identifiers.
GET /CodeSystem/{id}
Get the details of the Code System using the provided ID; it is the same operation for the supplement or the Exp. IDs code system.
PATCH /CodeSystem/{id}
Adds an expression in the Code System Supplement using a patch operation.
The display value can be generated from the expression, or the expression itself could be used in this field.
This operation should run validation on the expression being inserted into the supplement.
GET /CodeSystem/{supplementId}/$lookup?code={CTU}
GET /CodeSystem//$lookup?system={versionUri}&code={CTU}
Lookup Expression in the supplement
versionUri
CTU: close-to-user expression
Expression subsumption test
GET /CodeSystem/$subsumes
Test the subsumption between a pair of expressions or an expression and a code.
{
Create Concept Map for Exp Ids
POST /ConceptMap
(Only needed if EHR cannot store expressions)
Create the ConceptMap to map expressions in the code system supplement to expression identifiers in the Exp. Ids code system. This will be populated manually.
GET /ConceptMap/{snomed-exp-id-map}/$translate?system={versionUri}&code={CTU}
Example
GET /ConceptMap/snomed-exp-id-map/$translate?system=http://snomed.info/xsct/1234007
&code=87971000:272741003=7771000
Lookup Expression Identifier from Expression
versionUri
CTU: close-to-user expression
GET /ConceptMap/{snomed-exp-id-map}/$translate?
reverse=true&system={versionUri}&code={expId}
Example
GET /ConceptMap/snomed-exp-id-map/$translate?
reverse=true&system=http://snomed.info/snomed/exp-id/1101234&code=101101234165
Lookup Expression from Expression Identifier
versionUri
expId: expression identifier as defined pr. implementation
"resourceType": "CodeSystem",
"url": "http://snomed.info/info",
"version": "http://snomed.info/xsct/11000003104",
"content": "supplement",
"supplements" : "http://snomed.info/sct|http://snomed.info/sct/900000000000207008/version/20230131"
}Code System ID, provided in the response of the code system creation[
{
"op": "add",
"path": "/concept",
"value": {
"code": "359817006 |Closed fracture of hip (disorder)| :
272741003 |Laterality (attribute)| = 182353008 |Side (qualifier value)|",
"display": "Right closed fracture of hip"
}
}
] "resourceType": "CodeSystem",{
"resourceType": "CodeSystem",
"url": "http://snomed.info/snomed/exp-id/1000003",
"status": "active",
"content": "complete"
}{
"resourceType": "ConceptMap",
"url": "http://snomed.info/snomed/exp-id-map",
"status": "active",
"source": {
a0 a0 a0 a0"sourceUri": "http://snomed.info/xsct/1234007?fhir_vs"},
"target": {
a0 a0 a0 a0"targetUri": "http://snomed.info/snomed/exp-id/1101234?fhir_vs"}
}