UK Core Clinical and Technical Assurance Sprint 8 Documentation Pack
Please note:
- This Documentation Pack for Clinical and Technical Assurance Sprint 8 is for review purposes.
- Please follow the guidance on the "Contact Us" page if you need any assistance.
Please note:
- This is a 'technical sprint'. The scope of this sprint only includes improvements and fixes. New FHIR assets are out of scope for this sprint.
- The menu links for 'Use Cases', 'FHIR Assets' and 'Version Comparison' have been removed in this Documentation Pack.
Proposed Changes
This section documents proposed changes to be applied to the UK Core for the next release. These are highlighted to allow reviewers to comment on the proposed changes. Solutions for the issues which lead to these proposed changes may have been discussed on the Clinical and Technical Assurance Sprint 8 calls but can still be challenged by any reviewer.
| Number | Context | Type | Source | Issue | Proposal | Scope |
|---|---|---|---|---|---|---|
| Issue 1 | UKCore-Observation-Group-Lab (Profile) | Profiles | UK Core Developement Team | Profile has become redundant due to new element (Observation.organizer) in R6. | Retire UKCore-Observation-Group-Lab. Create guidance on using the new backport. Amend existing Group-Lab examples to use backport. | Proposed In Scope - Development Done |
| Issue 2 | UKCore-Observation-VitalSigns (Profile) | Profiles | UK Core Development Team | UKCore-VitalSigns has been derived from HL7 VitalSigns. This means we have to use LOINC codes, however:
|
Review why the Profile is derived from HL7 base Observation-VitalSigns. Consider potential options. | Proposed Out of Scope |
| Issue 3 | Profiles derived from Observation | Implementation Guide | UK Core Development Team | The predecessor to the UK Core C&TA7 was an NHSD Observations IG. This gave much more information on how to use the Observations, search terms, how they link. Now they are between all other Profiles with not enough guidance on usage, as found with the PDM team. | Propose splitting into separate IG to keep together with more specific information on how to use. | Proposed Out of Scope |
| Issue 4 | Packages | Naming convention | UK Core Development Team | Each STU version of package has a different name. | Propose using fhir.r4.ukcore x.0.0 to ensure standard approach and use correct project to separate major versions. | Proposed Out of Scope |
| Issue 5 | All FHIR assets | FHIR asset lifecycle process | UK Core Development Team | Having 'active' status after C&TA causes confusion. | Propose: 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? Click here for more information. |
Proposed In Scope - Development Done |
| Issue 6 | UKCore-Observation-AverageBloodPressure (Profile), UKCore-BloodPressure-Average (ValueSet) | Profile, ValueSet | UK Core User Community | Require clarification of the word 'average' to mitigate clinical risk. The existence of the profile UKCore-Observation-AverageBloodPressure with its wording mentioning 'average' in unclear and creates a potential clinical risk. There is also a lack of 'parameters'. | Need to understand a need for this profile as average has a variation of meaning e.g. 24 hours, 72 hours, 30 days readings etc. Due to the uncertain meaning of average, it is felt clinically to be unsafe to keep this resource. If a resource is required, then keep generic Blood Pressure and then add parameters e.g.: invasive blood pressure, laterality, position etc: By doing this, the ValueSet is more constrained as the VS as-is is too large. Until there is a use case and a requirement, this resource is too risky to pursue as is. | Proposed In Scope |
| Issue 7 | Sex | Implementation Guide | UK Core Development Team | There are many different extensions representing the sex of a patient, as well as Patient.gender. There is no clear guidance on which extensions, or the Patient.gender element, should be used for which use case. | Propose discussing how and where the patient's sex is described. | Proposed Out of Scope |
| Issue 8 | Observation panel (group) | Implementation Guide | UK Core Development Team | Lack of clarity on how Observations should be grouped, with the most common having unrelated items within a single Observation instance. | Propose guidance around how to group observations, similar to the lab one. May include creating an Observation-Group profile. | Proposed Out of Scope |
| Issue 9 | Extension-UKCore-CodingSCTDescDisplay (Extension) | Implementation Guide | UK Core Development Team | The IG guidance states that if the sct-descId is sent, then the UK Core sctdescDisplay SHALL be used. | The requirement should be changed from SHALL to MAY. | Proposed In Scope |
| Issue 10 | sct-descid | Implementation Guide | UK Core Development Team | Use of sct-descId for mapping and READ codes. The extension is only for showing a non-preferred term within SCT, linking it with the preferred term. If using other codes systems and mapping to SCT then both would go in seperate .coding elements, with userSelected chosen to represent the original. | Remove the word 'SHALL' in the guidance.
Guidance here Remove the extension from this example as not part of explanation and can cause confusion. Guidance here |
Proposed In Scope |
| Issue 13 | Parameter | FHIR Asset | UK Core Development Team | IG Publishing tool gives the following warning if you haven’t set the Snomed CT edition. | Propose to include SNOMED version in Parameter resource. | Proposed Out of Scope |
| Issue 15 | UKCore-Encounter (Profile) | Binding | Simplifier Issue | The binding is currently to https://simplifier.net/hl7fhirukcorer4/valueset-ukcore-dischargedestination. | Should be bound to hospitalization.destination | Proposed In Scope |
| Issue 16 | Encounter (Profile), Appointment (Profile), Slot (Profile) | Binding | Simplifier Issue | Appointment/Slot binds to http://terminology.hl7.org/CodeSystem/service-type | Propose to bind to https://fhir.hl7.org.uk/ValueSet/UKCore-CareSettingType (Uses SNOMED CT UK Refset with fully specified name 'Services simple reference set’) as it does in Encounter | Proposed In Scope |
| Issue 17 | UKCore-BloodPressure-Systolic (ValueSet) | Terminology Concepts | Simplifier Issue | Concepts to use when recording central venous pressure. Currently if you are representing a CVP or other invasive blood pressures, which appear to be in scope, there are no appropriate concepts to record the systolic and diasolic pressures. It would not be correct to use 271649006 | Systolic blood pressure (observable entity)as this is not what it is. So to represent correctly you would need to use a concept specifically for invasive blood pressure. | Propose to use a concept such as 276776003 |Right atrial pressure - a wave (observable entity) | or 276772001 |Right ventricular systolic pressure (observable entity)|. This would need validating with clinical experts. | Proposed In Scope |
| Issue 18 | UKCore-Observation-VitalSigns-BloodPressure (Profile) | Terminology Concepts | Simplifer Issue | There are 3 SNOMED CT codes used in this model top level to record the type of BP - then 2 codes to record the systolic and diastolic results/values. | For each top code it needs to be validated that there are clinically validated systolic concepts defined. Or even if the concept of systolic and diastolic is valid for CVP and invasive blood pressures. This need work with an expert in intensive care to validate. | Proposed In Scope |
| Issue 19 | UKCore-Observation-AverageBloodPressure (Profile) | Terminology Concepts | Simplifier Issue | The SNOMED CT concepts identified include invasive blood pressures but believe this should not be in scope. If they are then as for #3297 the concepts need validation with intensive care experts to validate that the concepts for the values and the units are all available. | If they are then as for #3297 the concepts need validation with intensive care experts to validate that the concepts for the values and the units are all available. | Proposed In Scope |
| Issue 21 | UKCore-AllergyManifestation (ValueSet) | Terminology | Simplifier Issue | Health issues simple reference set (1127581000000103) is retired. | No proposal stated. | Proposed In Scope |
| Issue 22 | UKCore-Observation-TobaccoConsumption (Profile), UKCore-TobaccoConsumption (ValueSet) | Modelling | UK Core Development Team | tobaccoConsuption profile only allows valueQuantity, but SNOMED CT UK has codes such as 160603005 | Light cigarette smoker (1-9 cigs/day) (finding)| | Propose loosening up to allow valueCodeableConcepts, with a valueset to include all types of tobacco use. | Proposed In Scope |