Known Issues & Future Development

Open issues are those for which no decision has been made, are pending feedback, or, for which there is an outstanding action. Issues are marked as closed when a decision has been made, or the issue resolved.

Feedback is requested on both open and closed issues. Instructions for feedback submission can be found at

Known Issues

1. Referenced ValueSets and CodeSystems are not resolvable.

   Some referenced ValueSets are not available at their canonical URL; some (particularly Canada-specific) ValueSets are not on the terminology servers used in IG publication (i.e. tx.fhir.org). Some referenced ValueSets are not currently available as FHIR R4 and may require conversion before use. Primarily, these issues impact validation against Canada Health Infoway-hosted ValueSets during development of derived Implementation Guides. (This doesn't affect deployed systems, since, in that environment, instances will be validated against locally present value sets.) For several of these ValueSets, "stub" resources have been created to stand-in within this Implementation Guide for the unresolvable ValueSets.

   Current guidance is to manually download the referenced value sets from, for example, the Terminology Gateway. Investigation is needed to determine if the problem ValueSets can be made "resolvable" through Infoway, or if they can be added to the standard terminology servers.

2. individual-RecordedSexOrGender

   This version socializes the RecordedSexOrGender Extension but current tooling requires for it to be "re-published" in this guide to pre-adopt an extension published in R5. This extension is an R4 (4.0.1) conversion of the canonical extension published in the R5 FHIR Extensions Pack. Implementers are advised to take note that the data type for the extension part sourceDocument (Reference) is not forwards compatible to the R5 type for that part (CodeableReference). No other material differences are present between the R4 extension published in this guide and R5 extension published the FHIR Extensions Pack.

   • When the extensions-registry package is formally published (following the 5.1.0 Ballot) and contains the cross-version details necessary to formally depend on it for the extension, the "re-published" extension will be able to be removed and replaced with a package dependency.

Closed Issues

1. AdditionalBinding Rendering

   This version introduces the AdditionalBinding Extension to convey additional terminology that is relevant under certain contexts (e.g., proposed for use with countries that do not have SNOMED CT licensing, utilized heavily in legacy data, etc.).
   • This extension is applied to the binding element and previously did not have rendering support in Simplifier (requiring the profile pages to indicate the terminology indicated as additional bindings). This rendering is now supported in the Simplifier interface.