• Retire UKCore-Observation-Group-Lab.
• Create guidance on using the new backport.
• Amend existing Group-Lab examples to use backport.

• Confirms active work uses Observation + hasMember (EU pattern); this topic aligns with earlier grouping need.
• Not uniform globally (some use DiagnosticReport as grouper), but majority trending to Observation hasMember; debate ongoing.

• Clarified distinction: earlier “grouping guidance” was generic; this item specifically retires the lab grouper.

• Asked whether international consensus is forming on panel modelling.

• all other vitalsigns not derived from hl7 specific vitalsigns, but from UKCore-VitalSigns, e.g. bmi, bp
• blood pressure, not derived from http://hl7.org/fhir/bp.html. slicing different to hl7 defined bp profile
• BodyWeight Internation uses unit = kg (required) , we use "kilogram". US seem to have made LOINC optional
• bmi base definition incorrect, should be http://hl7.org/fhir/StructureDefinition/bmi

• Keep to HL7 derived Observation, even if against dm+d (e.g. no `m` in height valueset)
• Derive from UK Core Observation and ignore HL7 derived Observation. This is possible as we are not deriving from them
• Derive from UK Core but ensure closely aligned, where practicable, to HL7 profiles

• Agreed: “too big/complex” for a technical sprint; risk of breaking things.
• Position this for a roadmap rather than quick fix.

• Asked for explicit rationale in the pack for why issues are out of scope (not just a list).
• Suggested also tracking proposed HL7 International changes arising from UK findings.

• Process is currently disjointed (gap between tech assurance vs ballot); align road map first.
• Acknowledged process hiccup; next Sprint should clarify inclusion/exclusion and sequencing.

• Observed derived profiles appear as active in the guide, causing confusion if they’re out of scope.

• Clarified the ballot status was draft, not balloted (corrected himself).

• It’s a process change reversing prior agreement; needs broader governance (HL7 UK / FIRE Board).

draft - actively worked on ready for ballot. Will show in build only active - balloted retired - not to be used for future work, but needs to be available for historical use. Does this need to be in a package?

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Main Points Raised in C&TA Calls:

Kevin Sprague:

• Historically made Active after Clinical & Technical Assurance (vendors reluctant to implement Draft).
• Proposal now: Active only after ballot; pre ballot content remains Draft but marked “assured” if it has been.
• Needs careful back shuffling and explanation in next release.

• Wants clear distinguishability between balloted and non balloted content.

• This belongs in the broader process refresh; current profile status options constrain what we can do; ensure consultation/engagement continues in any new model.

• HL7 UK working group will address this; must get it right the first time.

• If no implementations depend on it, deprecate now; revisit when use case is clear.

• Ask for direct, clear proposal sentence (“Retire the resource”) at the top, with rationale below.

• Implementation reality (Labs → GP): using Observation as grouper (EU pattern), back adopting R6 Observation.organizer Boolean; progressing in production.

• Will align with Phil offline; later slides include related R6 back port work in scope.
• Agreed: build a roadmap via FIRE Board; this sprint is alignment; process to be revamped.

• NHS Wales doing observation grouping for child growth charts—flag for future.

• Capture these real implementations and workarounds in the pack for community benefit.

• Pressed that imminent implementations should raise priority; advocated a roadmap to address pressing issues.

https://simplifier.net/guide/UK-Core-Implementation-Guide-STU3-Sequence/Home/Guidance/CodeableConcept-Guidance?version=current#Sending-a-SNOMED-CT-Description-ID-that-is-not-the-preferred-term

Main Points Raised in C&TA Calls:

Kevin Sprague:

• There’s a live vendor issue suggesting UK Core diverges from base FHIR behavior; reviewing; may need options (including deprecation).

• While under review, relaxing to MAY helps implementers and reduces harm.

• This should be solved internationally (HL7 + SNOMED), not by a UK only extension; avoid extending extensions; basic FHIR–SNOMED integration must be straightforward.

• Context: the need was to send a non preferred term text alongside the conceptId; past misuse included sending descriptionIds as codes.

• Confirmed: Read code should be its own coding entry; don’t use the SCT descriptionId extension to carry non SNOMED codes; simplify example.

• Not hurting anyone now; needs analysis and agreement—put on roadmap.

• Binding strength likely preferred (advisory, not enforced); this improves guidance without mandating.

• Short term: disallow non systemic/invasive usages under this profile until clarified; align with prior work.

• Distinguish systemic arterial blood pressure (vital signs) versus localised pressures (e.g., right atrial/ventricular).
• Invasive is OK if it reflects systemic arterial BP; otherwise use different concepts.
• Trim value sets; can share text/guidance and align with prior archetype work.

• Clarify what is “not OK”: don’t use the generic BP profile for localised pressures; use appropriate alternative model.

• Support: restrict BP profiles to left sided/systemic meanings; document how to record alternatives.
• Reminded that GP systems store triples (grouper + systolic + diastolic).

• Clinically: ward/GP “BP” ≠ ICU pressures; e.g., RAP reflects diastolic—mismatch under current systolic value set.

• Keep the top level “BP” code generic (as a grouper); actual semantics live in systolic/diastolic children; trim the top level value set.

• Document intended use as vital signs (ward/GP) to avoid scope creep.

• Treat 17 & 18 together; align with existing work (Ian’s).

• Will fall out naturally once BP scoping is corrected.

• Asked to replace “seems retired” with firm evidence; document how retirement is confirmed.

• Confirmed retirements; explained background (large, hard to maintain refsets; alternatives exist).
• Can suggest an alternative refset/binding if needed.
• IPS sets are too small/coarse for manifestations like rash subtypes; not ideal for UK clinical detail.

• Suggested considering IPS value sets for alignment.

• Illustrates why out of scope: needs proper multi party terminology session; add to roadmap.

• Revisit purpose and usage contexts (what needs comparability?); minimise UX burden.

• If quantities are captured, categories can be derived—understand why categorical terms are needed vs raw measures.

• Origin may be PRSB; will analyse GP usage stats for pre coordinated smoking concepts; note QoF complexity and that status ≠ single recording.

• Clinical priority is smoking status (current/ex/never) as the key risk factor; allowing coded consumption is fine, but ensure status is addressed (e.g., separate profile/element).

• Points to openEHR Tobacco Smoking Summary as a good reference for clinical data elements; AU FHIR uses archetypes to guide shapes.

• Primary fix now: correct the value set description (it wrongly says “level of consciousness”).
• Don’t over generalise—keep this profile focused on consumption; create separate value sets/profiles for smoking status and other perspectives; document intended use and misuse explicitly.

• Agreed: update description; consider additional artefacts but avoid burdening implementers.