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FHIR Ballot Prep

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This page lists the tasks to be completed by work groups in preparation for the R4 release of the FHIR core specification. The timelines for implementation guide publication and balloting may differ. Implementation Guides may choose to either publish in sync with the core specification (and actively manage dependencies as underlying resources and profiles are updated) or may choose to ballot later, once the FHIR specification is finalized. (The disadvantage of the latter approach is that changes to the core specification identified as part of implementation guide revision won't be able to be applied until a subsequent release)

The current schedule for the next connectathon/ballot base (Jan 2018)

  • Oct 18th - connectathon proposal deadline
  • Freeze deadlines will be the same as the Dec. ballot deadlines below:

Ballot schedule

Note that this schedule is considered to be quite firm. If there are concerns about meeting the target dates listed here, the likely outcome will be changing ballot status of artifacts (Normative down to STU, STU down to draft, lower FMM levels, drop content entirely). That said, if you have concerns about any of these dates, please contact your work group's FMG liaison or send an email to

Plan Overview

We expect that the R4 cycle will consist of 2-3 ballots:

  • January 2018 Cycle - Single For Comment Ballot: The purpose of this ballot is to provide an early review of Normative content to ensure quality is in place and identify as many substantive issues as possible in advance of the normative ballot. It also provides a QA point for other resources as we prepare for the "real" ballot. Tracker items received as a result of this ballot don't require formal resolution or change application prior to the opening of the following ballot, though work groups should do their best - prioritizing normative - to resolve what they can. Unresolved commenets will carry forward but will not carry ballot weight unless someone references them in a subsequent ballot.
  • May 2018 Cycle - Single STU ballot, multiple Normative ballots: This will be the "primary" ballot for R4. The normative content will be broken up into multiple packages (likely 3) to allow some packages to pass while others are dropped to 'STU' if necessary. FMM levels will be locked prior to this ballot and content here will require reconciliation. (Balloters might reference previously submitted tracker items, including items submitted as part of the For Comment ballot.)
  • Sept 2018 Cycle - possible Normative re-ballots and limited STU ballot: The primary purpose of this cycle is to allow reballoting of packages that are eligible to pass with only minor substantive changes or where one or more resources have been dropped from the package down to STU. *If* there is a second ballot for normative issues, then work groups balloting STU core content may petition for an additional STU ballot if they've made major revisions they feel justifies an additional ballot review. However, STU publications do not require reballot for substantive change and there will be little time for reconciliation and change application prior to the publication of R4, so this option needs to be considered carefully.

Publication of R4 will occur in mid-December 2018.

Detailed schedule

For comment ballot

2017-10-25 - Work groups inform the FMG of any implementation guides they'd like to ballot in Dec. cycle (strong preference to not ballot against R3 at this time unless essential for regulatory or similar reasons)

2017-11-15 - Work groups identify any changes (additions or removals) to the candidate list of Normative content

  • Framework, XML, JSON, RESTful API, Search
  • CodeSystem, ValueSet, ConceptMap. (But not all operations on those resources)
  • Bundle, OperationOutcome, Parameters, StructureDefinition, SearchParameter, CapabilityStatement, OperationDefinition
  • Patient, Observation

2017-12-10 - Substantive change freeze for core.

  • Normative candidates SHOULD have QA spreadsheet filled in and pass all QA. Related change logs should be clear. Should be no "Deferred" substantive changes
  • Any resource intended to be in R4 needs to be present in at least draft form

2017-12-17 - Final freeze (including IGs)

2017-12-22 - Ballot opens

2018-01-22 - Ballot closes

2018-01-27 - 2018-02-02: Jan WGM (New Orleans)

Primary ballot

Note: After this ballot, substantive changes can only be made to artifacts and pages marked "Normative" if they are in response to a ballot comment or the artifact has been dropped from its normative package back to STU status 2018-02-14 - Last date to inform FMG of intention to ballot IGs as part of May ballot. 2018-03-04 - FHIR Core substantive change freeze. IGs can still make changes. Work groups must inform product director what resources are to be treated as "draft" for this ballot (and for R4). 2018-03-11 - FHIR Core content total freeze. Normative candidates SHALL have QA spreadsheet filled in and pass all QA. Normative content should have tracker items cleared and no outstanding deferred QA tracker items. QA period opens for core and IG processes 2018-03-25 - QA changes may be applied 2018-04-01 - Final content freeze - no changes except with permission of product director 2018-04-06 - Ballot opens 2018-05-07 - Ballot closes 2018-05-12 - 2018-05-18: May WGM (Cologne)

Optional 3rd ballot 2018-07-01: Work groups notify the FMG whether they need to reballot normative packages (due to substantive change), STU resources (due to significant refactoring) or IGs during the Sept. cycle 2018-08-10: All substantive reconciliation applied. FHIR Core is frozen, limited QA process for content subject to ballot only 2018-08-17: Pre-ballot (and connectathon) content freeze. Publication process begins, including ensuring that content is appropriately flagged for ballot status and there are no last minute QA issues 2018-08-24: OptionalBallot opens 2018-09-24: Ballot closes and initial triage occurs. Note: No substantive changes allowed for normative candidates unless they drop to STU.

Final content changes and publication 2018-09-29 - 2018-10-05: October WGM (Baltimore). 2018-10-14: Final reconciliation packages posted for 2nd and 3rd ballots 2018-11-01: Substantive content freeze for core R4 publication including all substantive QA changes. Decision based on vote results and withdrawals about which normative packages to drop to STU. Implementation guides publishing as part of R4 may continue to make substantive changes. 2018-11-11: Final content freeze for R4 publication and start of QA period. No changes permitted for FHIR Core without product director permissions. Implementation Guides may update based on their QA processes 2018-11-25: QA period closes, QA change application begins 2018-12-02: FHIR core and FHIR IGs are all locked. No further changes without product director permission Finalization of FMM levels, final internal publication clean-up, publication process, TSC publication approval ~2018-12-15: Publication of R4 The world rejoices, Grahame sleeps

The current schedule for this release is as follows (dates will become more specific as we get closer):

  • Nov. 2017
    • All resources that are candidates for STU in R4 are included in spec in sufficient form to allow draft review
    • All artifacts & pages that are candidates for normative are identified to FMG
  • Dec. 2017
    • For Comment ballot on FHIR core spec
  • Mar. 2018
    • Final freeze for all R4 content.
  • Apr. 2018 STU/Normative ballot
  • Aug 2018
    • Potential limited ballot on substantive changes to normative artifacts and/or revision of normative scope
  • Nov 2018
    • Publication freeze
  • Dec 2018
    • R4 published