In the context of translating codesystems, this is what the CodeSystem resource says about designations:
In addition to the display and definition, a concept can have one or more designation elements. The display is equivalent to a special designation with an implied designation.use meaning "primary code/designation" and a language equal to the Resource Language. The designations can provide additional displays for other language, as well as designations for other purposes. When using concepts, applications use the display and designation unless the language or usage in context provides a reason to use one of the designations.
This is what the ValueSet resource about them:
In addition to the display, a concept can have one or more designation elements. The display is equivalent to a special designation with an implied designation.use of "primary code" and a language equal to the Resource Language. The designations can provide additional displays for other languages, as well as designations for other purposes. When using concepts, applications use the display unless the language or usage in context provides a reason to use one of the designations.
The text is pretty much the same, which is unfortunate, because there is a very big difference between the two! When translating 3rd party codesystems, designations should be added to the codesystem supplements, not valuesets. This is a bit of a footgun: without consulting Zulip, it's not possible to know the right way to use translation designations.
It would be great if the spec was clearer about this. Additionally, the IG publisher should give a warning/information message when adding language designations to valuesets - which is something you are unlikely to do. I imagine designations added to a valueset would be non-language ones, just like the LOINC code example in the spec.
See also the associated Zulip discussion.
- is voted on by
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BALLOT-91834 Negative - Reuben Daniels : 2026-Jan-FHIR R6 Norm
- Closed
- relates to
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FHIR-57375 Add new concepts to DesignationUse value set
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- Resolved - change required
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FHIR-57793 Add preferredForLanguage to designation-use value set
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- Applied
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