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Re: [Health-dev] [task #15027] A discussion on integrating HL7 FHIR (and

From: Chris Zimmerman
Subject: Re: [Health-dev] [task #15027] A discussion on integrating HL7 FHIR (and related) codesets into the data models
Date: Thu, 22 Nov 2018 20:55:26 +0000

Hi Luis, Andrew!

Sorry to resurrect this old topic but I wanted to slowly get started on these 

I would be glad to start the conversation with snomed about use and licensing. 
There is some concerning wording in that Humanitarian/Charitable exemption - 
"Any programs/material encoded with SNOMED CT will be deemed as SNOMED 
International's property." However, starting the dialogue is important.

On the other hand, although SNOMED CT is quite comprehensive there are areas it 
does not cover. For example, insurance type codes are defined by FHIR (with no 
equivalent in SNOMED, to my knowledge):

-public healthcare
-Insurance policy funded by a public health system such as a provincial or 
national health plan. Examples include BC MSP (British Columbia Medical 
Services Plan) OHIP (Ontario Health Insurance Plan), NHS (National Health 

There are many of these niche codesets which can be, as both of you suggested, 
added via a separate module. Adding a 'local code' column for ease of 
transition is a great idea. And even if other codesets ultimately supersede 
them (SNOMED, etc), having these selections/choices as a separate module makes 
updating much simpler.

All the best,


‐‐‐‐‐‐‐ Original Message ‐‐‐‐‐‐‐
On Tuesday, August 21, 2018 8:36 AM, Luis Falcon <address@hidden> wrote:

> Hi Andrew, Chris !
> On Sat, 18 Aug 2018 12:17:45 +0100 (BST)
> "address@hidden" address@hidden wrote:
> > Hi Chris
> > In the SHORT term I think that GNU Health might need to continue
> > using 'local codesets' with the option of also using a SCTID (SNOMED
> > CT Identifier) in the same database table:
> > Text description | Local code | SCTID
> > oral | PO | 123456789
> > intravenous | IV | 987654321
> > In the medium term I think that GNU Health should be configured with
> > the option of using/linking to a SCT TERMINOLOGY SERVER. This could
> > possibly be a new GNU Health module or could just be a web link to an
> > 'open source' terminology server.
> > An increasing number of countries are now licensed to use SNOMED CT
> > and those very low income countries can apply for the SCT free
> > license option.
> > Hope I have made myself clear.
> > What do you think Luis?
> > Andrew
> Agree with both of you.
> In our case, I believe we should be able to integrate it, under
> exemption 3[1].
> "Humanitarian/Charitable use: Offered strictly to not for profit
> organizations who would like to use SNOMED CT non-commercially, for the
> betterment of people living in rural areas and/or poorer countries."
> We can talk to them and make sure we are in the same track about
> providing unversality in healthcare.
> In any case, in my opinion is to create a separate module, that would
> allow to plug the datasets if the implementation context requires it.
> Let me know your thoughts
> 1.-

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