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Balloting and Publishing FHIR content

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In FHIR, there are only two mechanisms for publishing content that is based on the FHIR specification:

  • direct inclusion of content in the FHIR core specification
  • publication of a FHIR implementation guide

If an HL7 work group is seeking ballot review or publication of any artifact or collection of artifact that includes FHIR profiles, value sets, code systems, concept maps, logical models or any other structures that are based on the FHIR infrastructure, they will either be publishing that content as part of the FHIR core specification or they will be producing a FHIR implementation guide. The FMG does not permit the balloting or publication of FHIR artifacts except through one of those two mechanisms.

The expectations for work groups doing either of these is described below.

In all cases, the objectives are the same:

  • Ensure that the time and energy of the ballot community is respected
  • Ensure that guidance to the implementer community is clear
  • Ensure that content being published or submitted to ballot review is of high quality
  • Ensure that we create specifications we are confident will be adopted by the community

If development of content is funded, project sponsors should be aware of the expectations below and understand that while the FHIR Management Group strives to enable content to progress in a timely fashion, we cannot guarantee that content will progress in accordance with contractual or regulatory deadlines.

General expectations

These steps apply regardless of how how you're planning to get your content published:

1. Find an HL7 work group to sponsor the content. All content published by HL7 must be sponsored by (and maintained by) a work group. If you're not sure what work group is appropriate, ask on and the community will make recommendations. If the recommended group(s) are not able/willing to sponsor the content, you can approach the FHIR Management Group for advice.

2. Get your Project Scope Statement (PSS) approved. Your PSS must note an intention to produce FHIR artifacts and must receive approval from the FMG. The deadline for initial submission of the WG-approved PSS for consideration is generally 3 months prior to ballot opening. Because PSSs require multiple levels of approval, work groups should actively monitor (and nudge) their proposals through the process. They should also be prepared for the the rejection of the original PSS and the need to make significant edits and go through the process again. (I.e. Start on this sooner rather than later and if it's a funded project, be sure sufficient time is allowed.

Inclusion in core

Content included in the core specification might be resources, profiles, value sets, code systems or concept maps. For the latter 3 (the terminology resources), the administrative process is very light: submit a change request to be approved by the Vocabulary work group. If they believe the artifacts are of use internationally, the artifacts are well defined, and the content is appropriate to be maintained by HL7 international, they'll accept the proposals and incorporate the content into the specification.

For resources and profiles, the process is as follows:

  • Submit a Proposal using the wiki Resource or Resource template and send an email to requesting that the proposal be reviewed. The FMG will establish a deadline for this to be received in order to be eligible for ballot as STU. Typically this will be at least 6 weeks before ballot.
    • Be aware that in some cases, the FMG may want to see a draft of a proposed resource or get feedback from other work groups, connectathons and/or the community before approving the scope of a resource. Some resources may appear in one or more publications as "draft" before finally receiving FMG approval if the appropriat scope boundaries to meet the communities needs is unclear.
  • Source must be committed to HL7's gForge repository by at least one WGM prior to the ballot opening, possibly more to be a candidate for STU. (The FMG will announce if the deadline is earlier.)
    • In some cases, a work group might commit source to SVN prior to submitting a resource or profile proposal. Proposals are required to be submitted (but not necessarily approved) if an artifact is going to appear in a publication though.
    • Instructions for introducing a new resource can be found here
  • Balloting of the resource/profile will be driven by the FHIR Core ballot schedule as determined by the FMG.
  • Progression of the artofact will be governed by the FHIR Maturity Model
  • The FMG will determine whether draft artifacts are of sufficient quality and usefulness to be included when publishing a new FHIR release

Publishing an Implementation Guide

Implementation guides can be balloted and published on a separate timeline from the main specification.

Expectations for publishing implementation guides are as follows:

  • Source content must be maintained as a project under HL7's GitHub
  • The content must publish using HL7's continuous integration build publishing environment
  • The CI build must be set up and working with at least a subset of the profiles and other artifacts to be balloted by at least the WGM prior to the ballot where content will be published
  • An IG Proposal must be created and the FMG notified by sending an email to This must be *approved* by FMG prior to submitting the NIB for the implementation guide (so submitting to the FMG should occur at least 3 weeks prior to NIB deadline).
  • "Comment only" ballots will only be supported if the work group has a specific objective for using the 'comment only' ballot that cannot be met with a less formal mechanism such as a peer review or a frozen snapshot published for connectathon purposes. Multiple "comment only" ballots prior to an STU or Normative ballot are strongly discouraged.
  • Artifacts in an IG cannot be balloted as STU or normative unless the underlying artifact (resource, value set, profile, etc.) already has or is being balloted at the same or a higher level and cannot be published until the underlying artifact has the same or a higher level. I.e. You can't publish a portion of an IG as Normative if it relies on resources that did not pass Normative ballot.
  • Additional guidance on IG timelines can be found here