• BREAKING CHANGE: Changed UK Core Minimum Viable Content to be MustSupport flags
• BREAKING CHANGE: Renamed ukcore-imm-1 constraint to ukcore-imm-001, due to a codified design approach to constraint naming
• BREAKING CHANGE: Reset minimum cardinality on UKCore-Practitioner.identifier sub element system and value from 1 to 0
• BREAKING CHANGE: Updated datatypes in extensions UKCore-AddressKey, UKCore-BirthSex, UKCore-OtherContactSystem using code or coding datatypes to CodeableConcept, due to updated FHIR modelling principles
• BREAKING CHANGE: Updated binding strength in extensions UKCore-EthnicCategory, due to a codified design approach to bindings
• BREAKING CHANGE: Reset UKCore-Patient.communication.language to base binding, and increased the strength to Required, this is to bring this element in line with future FHIR versions

• BREAKING CHANGE: Changed ukcore-diag-lab-001 constraint from 'effectivetime' to 'issued'
• BREAKING CHANGE: Renamed UKCore-Observation-LabGroup to UKCore-Observation-Group-Lab
• BREAKING CHANGE: ValueSet UKCore-UnifiedTestList has been retired, and replaced by two new valusets, with new SNOMED CT reference sets
• BREAKING CHANGE: Updated datatypes in extensions UKCore-ConditionEpisode, UKCore-DeliveryChannel, UKCore-ListWarningCode using code or coding datatypes to CodeableConcept
• BREAKING CHANGE: Updated binding strength in extensions UKCore-AdmissionMethod, UKCore-DischargeMethod, UKCore-LegalStatus, UKCore-OutcomeOfAttendance to extensible
• BREAKING CHANGE: Removed 'issue' from CodeSystem UKCore-ConditionCategory

• Reset the following profiles: UKCore-Consent, UKCore-EpisodeOfCare, UKCore-Flag, UKCore-ImagingStudy, UKCore-MessageHeader, UKCore-OperationOutcome, UKCore-QuestionnaireResponse, UKCore-QuestionnaireResponse, UKCore-Task to draft status, and removed from the STU2 Sequence release (available in the STU3 Sequence draft package)
• Reset the referencing on all profiles to base resources, with an intelligent redirect within the IG to the UK Core profile guidance page
• Added intelligent redirect within the IG tree view for FHIR datatypes, and Reference(Resource)
• Added additional UKCore-Questionnaire and UKCore-QuestionnaireResponse examples, using SNOMED CT
• Added additional UKCore-DiagnosticReport examples
• Improved existing UKCore-DiagnosticReport examples
• Fixed cardinalities on Extension.extension on complex extensions
• Replaced UKCore-Consent.provision.code binding from LOINC to SNOMED CT
• Added additional guidance around the lack of a defined ValueSet for UKCore-Specimen.collection.extension:specialHandling
• Added additional guidance around the lack of a suitable ValueSet for UKCore-Observation-Lab.dataAbsentReason
• Changes to CodeableConcept guidance
• Fixed typos
• Renamed the ID of the preadopted R5 DiagnosticReport.Note extension
• Preadopted R5 DiagnosticReport.supportingInfo extension
• Preadopted R5 Observation.bodyStructure extension
• Altered UKCore-DiagnosticReport-Lab to not be derived from UKCore-DiagnosticReport
• Altered UKCore-Observation-Lab and UKCore-Observation-Group-Lab, to not be derived from UKCore-Observation
• Altered UKCore-ServiceRequest-Lab to not be derived from UKCore-ServiceRequest
• Altered slices used in UKCore-DiagnosticReport-Lab, UKCore-Observation-Lab, UKCore-ServiceRequest-Lab
• Updated IG menu structure / functionality

• Fixes to name/title element on Extension-UKCore-CodingSCTDescDisplay, Extension-UKCore-CollectionCollector, Extension-UKCore-OutcomeOfAttendance, UKCore-Observation-LabGroup, ValueSet-UKCore-BiopsyState
• Fix on incorrect wording in code tag on ImagingStudy.series.performer.actor
• Fix on submenu creation on mobile devices
• Added ballot box on Extension-UKCore-SampleCategory
• AddedUKCore-MessageHeader to Profile Index page lists
• Fixed incorrect Alphabetical listing headers from A-D,D-L,M-P,P-Z to A-D,E-L,M-P,Q-Z
• Adjusted wording from Ballot 2, to STU2 ballot

• Added draft C&TA Sprint 6 Profiles (UKCore-Consent, UKCore-DiagnosticReport, UKCore-FamilyMemberHistory, UKCore-ImagingStudy, UKCore-Observation, UKCore-Specimen) and associated Extensions, ValueSets, and CodeSystems.
  
  
• For UKCore-DiagnosticReport:
  • Added a Derived Profile: UKCore-DiagnosticReport-Lab
  • Removed slices on category, code, conclusionCode
  • Added Extension UKCore-DeviceReference
  • Added backported R5 elements as proxy extensions using R5 url's for note, composition
  • Reverted code binding from UKCore-FindingCode to base ValueSet as they were identical
• For UKCore-FamilyMemberHistory:
  • Added a existing Extension UKCore-AssociatedEncounter
  • Added backported R5 element as proxy extensions using R5 url's for participant
  • Bound relationship to ValueSet UKCore-PersonRelationshipType
  • Existing base bindings have been assured, and strength raised to preferred or extensible, in line with the Design and Development Approach
  • Retired draft Extension UKCore-Recorder, as this is replaced by backported R5 element participant
• For UKCore-Observation:
  • Added Derived Profiles: UKCore-Observation-LabGroup and UKCore-Observation-Lab
  • Removed slices on code, bodySite
  • Reverted bodySite binding from UKCore-BodySite to base ValueSet as they were identical
  • Addded backported R5 element as proxy extensions using R5 url's for <triggeredBy
• For UKCore-Specimen:
  • Removed slices on type, collection.bodySite
  • Added Extension UKCore-SampleCategory
  • Added Extension UKCore-BodySiteReference, to replicate CodeableReference allowed in R5
  • Added backported R5 element as proxy extensions using R5 url's for collection.collector, to replicate additional references allowed in R5
  • Added ValueSet UKCore-SpecimenCondition, bound to condition, which extends the base ValueSet, with CodeSystem UKCore-BiopsyState
• For UKCore-ServiceRequest:
  • Added Derived Profiles: UKCore-ServiceRequest-Lab
  • Added Extensions UKCore-AdditionalContact, UKCore-PriorityReason, UKCore-Coverage
  • Added an open slice to category, discriminated by coding.system, to the ValueSet UKCore-GenomicsSequencingCategory
• For UKCore-Patient:
  • Added Extension UKCore-NHSNumberUnavailableReason
• For UKCore-Organization:
  • Added ValueSet UKCore-OrganizationType, bound to type, which extends the base ValueSet, with CodeSystem UKCore-OrganizationTypeGenomics
  
  
• Added guidance to clarify that using the FHIR UK Core also requires the base specification, following feedback from implementers.
• Added guidance and snippet example for sending a local language translation, following feedback from implementers.
• Added canonical urls to Extension and Profile pages via FQL, following feedback from implementers.
• Added last updated date and version to Profile pages via FQL, following feedback from implementers.
• Added the display of CodeSystem descriptions via FQL, following feedback from implementers.
• Added alternative alphabetical/by sprint/by resource renderings of the Extensions, Profiles, and ValueSet/CodeSystem indexes, following feedback from implementers.
  
  
• Updated all draft sprint 6 assets to active status.
• Updated Extension and CodeSystem sub pages to use FQL to display the description, to improve IG consistency.
• Updated the name of ValueSet UKCore-ReportCodeSnCT to UKCore-ReportCode.
• Updated CodeSystem descriptions, where the CodeSystem is populated from Data Dictionary sources to include markdown links, following feedback from implementers.
• Updated ValueSet UKCore-SpecimenType, added during CTA sprint 6, to include descendantOf 123037004 | Body structure and descendantOf 123038009 | Specimen.
  
  
• Improved consistency of the ordering of elements shown in Extension and Binding (differential) tables within the IG, following feedback from implementers.
• Improved the table based render of examples, to generate html links between referenced examples.
• Improved the drop down menu items for better navigation, and faster page loads.
  
  
• Removed Hybrid / Differential tree views from the Extensions Library.

HL7 guidance for using R5 elements in R4 as extensions exists: https://hl7.org/fhir/versions.html#extensions, but as of 19/05/2023, the package to enable pre-adopted elements to function as per the guidance, is not available. To enable rendering and vaidation of these pre-adopted elements, we have provided UK Core proxy extensions, as per the current threads on chat.fhir.org. These proxy extensions match the R5 element as closely as possible, and contain the R5 canonical urls. These proxy extensions will be removed once the HL7 package is released.

• BREAKING CHANGE: Updated Extension-UKCore-AdmissionMethod to be expressed at UKCore-Encounter.hospitalization level.
  
  
• Retired UKCore-MedicationPrecondition ValueSet, and reverted to base binding on UKCore-MedicationDispense.dosageInstruction.asNeeded[x], UKCore-MedicationRequest.dosageInstruction.asNeeded[x], UKCore-MedicationStaement.dosage.asNeeded[x] following terminology guidance, which resulted in the valueset matching the base ValueSet.
• Retired Extension-UKCore-AnestheticIssues on UKCore-Procedure, as this extension was not deemed appropriate for use, as it can be represented through the use of the existing resources and profiles, UKCore-AllergyIntelorance and AdverseEvent.
• Retired Extension-UKCore-ActualProblem, Extension-UKCore-ProblemSignificance, Extension-UKCore-RelatedClinicalContent, Extension-UKCore-RelatedProblemHeader as these extensions were deemed to be England and GPConnect specific.
• Retired Extension-UKCore-MessageHeaderInstruction as the CodeSystem was empty, and the extension was deemed to be England specific.
  
  
• Removed the retired extensions mentioned above from UKCore-Condition and UKCore-List.
• Removed UKCore-BodySite ValueSet binding, and reverted to base binding on UKCore-Condition.bodySite, UKCore-Procedure.bodySite, UKCore-ServiceRequest.bodySite as the contents matches the base ValueSet.

• Added C&TA Sprint 4 Profiles (UKCore-Composition, UKCore-Condition, UKCore-Encounter, UKCore-EpisodeOfCare, UKCore-List, UKCore-MessageHeader, UKCore-OperationOutcome,UKCore-Procedure, UKCore-RelatedPerson) and associated Extensions, ValueSets, and CodeSystems
• Added C&TA Sprint 5 Profiles (UKCore-Appointment, UKCore-Flag, UKCore-HealthcareService, UKCore-Questionnaire, UKCore-QuestionnaireResponse, UKCore-Schedule, UKCore-ServiceRequest, UKCore-Slot, UKCore-Task) and associated Extensions, ValueSets, and CodeSystems.
  
  
• Added missing publisher values to Extension-UKCore-DeliveryChannel, and Extension-UKCore-RelatedClinicalContent.
• Added new CodeSystem, and ValueSet UKCore-MedicationAdministrationCategory, extending the FHIR International medication-admin-category ValueSet with a discharge code, and set as "extensible" against UKCore-MedicationAdministration.category at the request of Digital and Interoperable Medicines.
• Added new primarycare code to CodeSystem, and ValueSet UKCore-MedicationRequestCategory at the request of Digital and Interoperable Medicines.
• Added SNOMED CT concept 419841000001106 | "Clinical trial medication" as an include in ValueSet UKCore-MedicationCode at the request of Digital and Interoperable Medicines.
• Added SNOMED CT concepts 429060002 | "Procedure to meet occupational requirement", and 281657000 | "Travel vaccinations" as an include in ValueSet UKCore-ImmunisationExplanationReason following clinical review.
  
  
• Updated CodeSystem UKCore-PersonMaritalStatusEngland to add missing codes, and ValueSet UKCore-PersonMaritalStatusCode to filter codes in order to remove duplicaton of FHIR International codes (retroactively added to 1.0.1 as well)
• Removed Extension UKCore-ContactRank from the UKCore-RelatedPerson Profile (retroactively added to 1.0.1 as well)
• Updated all contact tags in all Profiles, Extensions, ValueSets, and CodeSystems (retroactively added to 1.0.1 as well)
• Updated UKCore-MedicationCode ValueSet binding strength from "extensible" to "preferred" on UKCore-Medication, UKCore-MedicationAdministration, UKCore-MedicationDispense, UKCore-MedicationRequest, UKCore-MedicationStatement (retroactively added to 1.0.1 as well)
  
  
• Updated all Profile description and purpose elements after clinical review, and included markdown links to enable FQL use in the IG.
• Updated UKCore-MessageHeader.event[x] binding strength from "extensible" to "example", retired empty CodeSystem UKCore-MessageEvent, and updated ValueSet UKCore-MessageEvent to include and expand 2 NHS CodeSystems for message events.
• Updated the binding strength of all ValueSets which primarily include concepts from SNOMED CT or dm+d, from "extensible" to "preferred".
• Updated UKCore-Appointment, UKCore-HealthcareService, UKCore-Schedule, UKCore-Slot to bind their specialty element to ValueSet UKCore-PracticeSettingCode, in line with UKCore-PractitionerRole.
• Updated UKCore-PractitionerRole.healthcareService to replace the reference to HealthcareService with UKCore-HealthcareService.
• Updated UKCore-Procedure.instantiatesCanonical to replace the reference to Questionnaire with UKCore-Questionnaire.
• Updated ValueSet UKCore-ConditionEpisodicity to use the https://fhir.hl7.org.uk/CodeSystem/UKCore-ConditionEpisodicity system url instead of the old https://fhir.nhs.uk/R4/CodeSystem/UKCore-ConditionEpisodicity url.
• Updated ValueSet UKCore-ListWarningCode to use the https://fhir.hl7.org.uk/CodeSystem/UKCore-ListWarningCode system url instead of the old https://fhir.nhs.uk/R4/CodeSystem/UKCore-ListWarningCode url.
• Updated the minimum cardinality of the value[x] element on the following Extensions: UKCore-ActualProblem, UKCore-BookingOrganization, UKCore-DeliveryChannel, UKCore-EncounterTransport (retired), UKCore-LegalStatus, UKCore-ProblemSignificance, UKCore-RelatedClinicalContent, UKCore-RelatedProblemHeader, in line with UK Core Design and Development Approach.
  
  
• Removed filtering of FHIR International CodeSystem medication-statement-category codes in ValueSet UKCore-MedicationStatementCategory.
  
  
• Fully qualified guidance within an IG page to include the resource, so it reads as resource.element rather than just element.

For most clinical data exchanges dm+d or SNOMED CT is the expected CodeSystem to use and this was why historically the ValueSet binding strength for these systems was set as 'extensible', however there are many use cases where this is not possible. For example:

• The data is historical and previously coded in another terminology such as READ,
• The sending system does not support dm+d or SNOMED CT,
• Finding a valid alternative dm+d or SNOMED CT code for one that is not in the CodeSystem is labour intensive due to the size of these CodeSystems.

For these reasons it has been decided to reduce the binding strength for all ValueSets containing dm+d or SNOMED CT codes to 'preferred'.