201709 Terminology Services Track

Return to Sept 2017 Proposals

Terminology Services

Submitting WG/Project/Implementer Group

FHIR Management Group (FMG)

Justification

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 set resource, and the underlying code systems. 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.

David Hay's blog post on Terminology Services

Track Administration

Coordinator: Rob Hausam

Management & Communications: Zulip Chat Stream

Test Support: Richard Ettema

Terminology Services Track Report

FHIR Connectathon 16 was held on September 9-10, 2017 in San Diego.
This is a link to download the report from the Terminology Services Track.

Expected participants

• Health Intersections - FHIR Server
• AEGIS - Touchstone tool and test scripts
• Apelon (Most recent build): http://fhir.ext.apelon.com:7080/dtsserverws/fhir and Demo Page at http://fhir.ext.apelon.com:7080/DtsOnFhirDemo/logon/Logon.action
  • Through a collaboration with the American Medical Association, the Current Procedural Terminology (CPT®) is now available for use in FHIR development efforts through the Apelon DTS on FHIR® service. Authentication is required. Please send an email to support@apelon.com for a user/pass. Please note that use of CPT® for production or commercial purposes through this service is prohibited.
• Lantana - FHIR services on Trifolia
• CSIRO Australia - Ontoserver
• NLM - FHIR services on VSAC
• IMO - FHIR services on IMO ProblemIT/ProcedureIT
• Patients First NZ Terminology Server
• Health Language FHIR terminology services
• Hausam Consulting test server

• Additional servers and clients

Roles

FHIR Terminology Server

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

• $expand - Value Set Expansion
• $validate-code - Value Set Validation
• $lookup - Concept Lookup
• $subsumes - Subsumption Testing
• $translate - Concept Translation
• $closure - Maintaining a Closure Table

Support additional capabilities:

• Expansion Profile (Maturity Level: 2) - Defining constraints on the Expansion of a FHIR ValueSet
• SNOMED CT and LOINC implicit value sets - using SNOMED CT with FHIR and using LOINC with FHIR
• $compose - Code Composition based on supplied properties (experimental)

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
• 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
• Experiment with the capabilities of the expansion profile (see description above of the expected capabilities and scenarios)
• 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/r3). Other servers, including the Apelon server (http://fhir.ext.apelon.com/dtsserverws/fhir) and the others listed above will support several of these operations and capabilities. For a list of functions supported by the Apelon Server, see the demo web app (http://fhir.ext.apelon.com/DtsOnFhirDemo, uid/pwd dtsadminuser/dtsadmin).

Pre-Requisites

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

Test Scripts

Starting with the Connectathon 16 event in San Diego, this track now includes additional levels of testing that introduce more formalized execution and reporting of test results. Furthermore, none of the Client and Server Assigned Id Test Scripts, used for the $expand and $validate-code operations in previous events, have been carried forward to this Connectathon. The expectation now is that the FHIR Terminology Servers under test will have already downloaded and installed the required resources (Code Systems, Value Sets & Concept Maps).

These resources, and the corresponding TestScripts, have been committed to the FHIR documents Github repository at: FHIR documents Github repository Please contact Graham 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:

• Terminology Test Definition Spreadsheet - Example proposals for Terminology tests (positive and negative)

Scenarios & Tasks

Level 1 - Introduction to Terminology

This has been and will remain the 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 publically-available FHIR Terminology Servers listed above.

Testing and test reporting at the Connectathon event will be self-attested using the Results tab of the Tracking Spreadsheet (link TBD) and primarily involve peer-to-peer execution between known FHIR clients and/or servers.

Level 2 - Formal Testing of Terminology - Participants with FHIR experience

(Level 1 +) This level 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 is significantly leveraged for both automated testing (testing tool to FHIR 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 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.

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-16-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-16-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.

Test Scripts - CodeSystem Lookup - $lookup

• connectathon-16-ts-lookup-loinc - $lookup tests where the FHIR Terminology server is expected to have the LOINC code systems available.
• connectathon-16-ts-lookup-snomed - $lookup tests where the FHIR Terminology server is expected to have the SNOMED-CT code systems available.

Test Scripts - CodeSystem Subsumes - $subsumes

• connectathon-16-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-16-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-16-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-16-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-16-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-16-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-16-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-16-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-16-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-16-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-16-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-16-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 - ValueSet Validate Code - $validate-code

• connectathon-16-ts-validate-code - $validate-code tests where the FHIR Terminology server is expected to have the LOINC and SNOMED-CT code systems available.
• connectathon-16-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.