fhirsmith 0.17.0 → 0.18.1

package/tx/cs/cs-snomed.js

@@ -31,6 +31,18 @@ const Logger = require("../../library/logger");
 // shared - it simply recomputes.
 const SNOMED_FILTER_ANALYSIS = Symbol('snomedFilterAnalysis');
 
+/**
+ * Alternate identifier schemes (sct2_Identifier) that FHIRsmith knows how to present:
+ * the code system the identifiers are codes in, and the $lookup property they are
+ * returned as. An identifier in an unknown scheme is kept but not reported.
+ */
+const IDENTIFIER_SCHEMES = {
+  '30051010000102': { system: 'http://loinc.org', property: 'loinc' }   // |LOINC code identifier| (LOINC Extension)
+};
+
+/** The $expand / ECL-free filter on alternate identifiers: mapped:<scheme> exists true|false */
+const MAPPED_FILTER_PREFIX = 'mapped:';
+
 // Description language index -> language code. The index is assigned at import
 // time by SnomedImporter.mapLanguageCode(); this table is its inverse and must
 // be kept in step with it.
@@ -46,6 +58,24 @@ const SCT_LANGUAGE_CODES = {
   9: 'cs'
 };
 
+// ECL dialect aliases (ECL specification, appendix "Dialect aliases") to the
+// language reference set they denote. Used by {{ D dialect = en-gb }}.
+const ECL_DIALECT_ALIASES = {
+  'en-us': '900000000000509007',
+  'en-gb': '900000000000508004',
+  'en-au': '32570271000036106',
+  'en-ca': '19491000087109',
+  'en-nz': '271000210107',
+  'en-ie': '21000220103',
+  'fr-ca': '20581000087109',
+  'fr-be': '21000172104',
+  'nl-be': '31000172101',
+  'nl-nl': '31000146106',
+  'es-es': '448879004',
+  'sv-se': '46011000052107',
+  'da-dk': '554461000005103'
+};
+
 // Context kinds matching Pascal enum
 const SnomedProviderContextKind = {
   CODE: 0,
@@ -174,6 +204,47 @@ class SnomedServices {
     // means "could not decide", and leaves the value unchecked.
     this.expressionServices.eclConstraintMatcher = (constraint, value) => this.mrcmRangeSatisfied(constraint, value);
     this._mrcmRangeCache = new Map();
+
+    this.#loadIdentifiers(sharedData.identifiers || []);
+  }
+
+  /**
+   * Index the alternate identifiers (sct2_Identifier rows, active only, as
+   * [scheme, module, code, conceptId]) both ways: concept -> identifiers, and
+   * scheme|code -> concepts. Also which modules carry identifiers, since each such
+   * module defines an implicit map (?fhir_cm=<module>).
+   */
+  #loadIdentifiers(rows) {
+    this.identifiersByConcept = new Map();
+    this.conceptsByIdentifier = new Map();
+    this.identifierModules = new Map(); // module -> Set of schemes
+    for (const [scheme, module, code, conceptId] of rows) {
+      const entry = { scheme, module, code };
+      if (!this.identifiersByConcept.has(conceptId)) {
+        this.identifiersByConcept.set(conceptId, []);
+      }
+      this.identifiersByConcept.get(conceptId).push(entry);
+      const key = scheme + '|' + code;
+      if (!this.conceptsByIdentifier.has(key)) {
+        this.conceptsByIdentifier.set(key, []);
+      }
+      this.conceptsByIdentifier.get(key).push(conceptId);
+      if (!this.identifierModules.has(module)) {
+        this.identifierModules.set(module, new Set());
+      }
+      this.identifierModules.get(module).add(scheme);
+    }
+  }
+
+  /** The alternate identifiers of a concept (by id), optionally only those of one scheme */
+  getIdentifiers(conceptId, scheme = null) {
+    const list = this.identifiersByConcept.get(String(conceptId)) || [];
+    return scheme ? list.filter(i => i.scheme === scheme) : list;
+  }
+
+  /** The concept ids that have the given code in the given scheme */
+  getConceptsForIdentifier(scheme, code) {
+    return this.conceptsByIdentifier.get(scheme + '|' + code) || [];
   }
 
   /**
@@ -568,6 +639,122 @@ class SnomedServices {
     }
   }
 
+  /**
+   * The module this edition is published under, as a concept index (0 if it cannot be found),
+   * taken from the edition URI http://snomed.info/[x]sct/<module>[/version/<date>]
+   */
+  editionModule() {
+    const m = /^http:\/\/snomed\.info\/x?sct\/(\d+)/.exec(this.getVersion() || '');
+    if (!m) return 0;
+    const r = this.concepts.findConcept(m[1]);
+    return r.found ? r.index : 0;
+  }
+
+  /**
+   * The module dependency reference set (900000000000534007). Found by its defining concept
+   * when that is present; a subontology extract may carry the members without the concept,
+   * so the filename-derived refset name is the fallback.
+   * @returns {object|null} the reference set record
+   */
+  moduleDependencyRefSet() {
+    if (this._mdrs !== undefined) return this._mdrs;
+    this._mdrs = null;
+    const r = this.concepts.findConcept('900000000000534007');
+    for (let i = 0; i < this.refSetIndex.count(); i++) {
+      const rs = this.refSetIndex.getReferenceSet(i);
+      if ((r.found && rs.definition === r.index) || this.strings.getEntry(rs.name).startsWith('ModuleDependency')) {
+        this._mdrs = rs;
+        break;
+      }
+    }
+    return this._mdrs;
+  }
+
+  /**
+   * The modules that the given module depends on, per the module dependency reference set:
+   * [{module: <concept index>, sourceEffectiveTime, targetEffectiveTime}]. Only the direct
+   * dependencies - the dependencies of those modules are their own rows.
+   */
+  moduleDependencies(moduleIndex) {
+    const rs = this.moduleDependencyRefSet();
+    if (!rs || !moduleIndex) return [];
+    const result = [];
+    for (const m of this.refSetMembers.getMembers(rs.membersByRef)) {
+      if (m.module !== moduleIndex || !m.ref) continue;
+      // values are [value, type, value, type...]; both fields here are strings
+      const vals = m.values ? this.refs.getReferences(m.values) || [] : [];
+      const str = (i) => vals.length > i && vals[i + 1] === 5 ? this.strings.getEntry(vals[i]) : null;
+      result.push({ module: m.ref, sourceEffectiveTime: str(0), targetEffectiveTime: str(2) });
+    }
+    return result;
+  }
+
+  /**
+   * The concept indexes of all the modules that make up the edition published under the
+   * given module: the module itself and, transitively, everything it depends on.
+   */
+  editionModules(moduleIndex) {
+    const result = new Set();
+    const todo = [moduleIndex];
+    while (todo.length) {
+      const m = todo.pop();
+      if (!m || result.has(m)) continue;
+      result.add(m);
+      for (const d of this.moduleDependencies(m)) todo.push(d.module);
+    }
+    return result;
+  }
+
+  /**
+   * Translation from this edition to another edition it depends on (see
+   * SnomedProvider.translateToEdition). The target is an edition URI,
+   * http://snomed.info/sct/<module>[/version/<date>]; the result says which module and
+   * version that is, and which modules' content belongs to it, or null if this edition
+   * does not depend on it (or not on that version of it).
+   */
+  editionDependency(targetEdition) {
+    const m = /^http:\/\/snomed\.info\/x?sct\/(\d+)(?:\/version\/(\d{8}))?$/.exec(targetEdition || '');
+    if (!m) return null;
+    const mine = this.editionModule();
+    const target = this.concepts.findConcept(m[1]);
+    if (!mine || !target.found) return null;
+    for (const d of this.moduleDependencies(mine)) {
+      if (d.module === target.index && (!m[2] || m[2] === d.targetEffectiveTime)) {
+        const version = d.targetEffectiveTime ? `http://snomed.info/sct/${m[1]}/version/${d.targetEffectiveTime}` : `http://snomed.info/sct/${m[1]}`;
+        return { moduleId: m[1], moduleIndex: target.index, version, modules: this.editionModules(target.index) };
+      }
+    }
+    return null;
+  }
+
+  /**
+   * The concept whose normal form is the given expression, if there is one. The index is
+   * built on first use: every defined concept's stored normal form, rendered in the minimal
+   * form so that two expressions compare as strings.
+   * @param {string} rendered - the expression, rendered with SnomedServicesRenderOption.Minimal
+   * @returns {number} the concept index, or -1
+   */
+  conceptWithNormalForm(rendered) {
+    if (!this._normalFormIndex) {
+      const index = new Map();
+      const total = this.concepts.count();
+      for (let ord = 0; ord < total; ord++) {
+        const c = this.concepts.getConceptByCount(ord);
+        if ((c.flags & 0x0F) !== 0 || this.concepts.getNormalForm(c.index) === 0) continue;
+        try {
+          const nf = this.expressionServices.createNormalForm(c.index);
+          const key = this.expressionServices.renderExpression(nf, SnomedServicesRenderOption.Minimal);
+          if (!index.has(key)) index.set(key, c.index);
+        } catch (e) {
+          // a normal form that cannot be built is simply not indexed
+        }
+      }
+      this._normalFormIndex = index;
+    }
+    const r = this._normalFormIndex.get(rendered);
+    return r === undefined ? -1 : r;
+  }
+
   getConceptRefSet(conceptIndex, byName = false) {
     for (let i = 0; i < this.refSetIndex.count(); i++) {
       const refSet = this.refSetIndex.getReferenceSet(i);
@@ -583,13 +770,8 @@ class SnomedServices {
   // members" (returns a numeric membersByRef, which may be 0 or the
   // MAGIC_NO_CHILDREN sentinel). Used by memberOf to reject non-refset operands.
   _findRefSetMembersRef(conceptIndex) {
-    for (let i = 0; i < this.refSetIndex.count(); i++) {
-      const refSet = this.refSetIndex.getReferenceSet(i);
-      if (refSet.definition === conceptIndex) {
-        return refSet.membersByRef;
-      }
-    }
-    return null;
+    const refSet = this._findRefSetRecord(conceptIndex);
+    return refSet ? refSet.membersByRef : null;
   }
 
   // Filter support methods
@@ -724,12 +906,21 @@ class SnomedServices {
    *   >> (ancestor-or-self-of)
    *   >! (strict ancestor-of)
    *   >  (parent-of)
-   *   ^  (member-of refset)      — refset must be a plain concept ID
+   *   ^  (member-of refset)      — a concept or any bracketed expression, with
+   *                                 {{ M ... }} member filters
    *   *  (wildcard)
+   *   hierarchy operators on *, ^ and bracketed sets (applied per member)
    *   AND / OR / MINUS compound expressions
+   *   !!> / !!< (top / bottom of set)
+   *   refinements (= against an expression, attribute AND/OR/",", groups,
+   *   attribute and group cardinality, attribute names that are expressions),
+   *   dotted expressions, {{ C ... }} concept filters, {{ D ... }} description
+   *   filters, comments
    *
-   * Everything else (refinements, dotted expressions, cardinality,
-   * reverse attributes, numeric/string comparisons) throws an informative error.
+   * Everything else (reverse attributes, != and concrete (numeric/string/
+   * boolean) values in refinements, alternate identifiers, reference set field
+   * selection on ^, {{ + ... }} history supplements) throws an informative
+   * error which is reported as UNSUPPORTED_ECL.
    */
 
   /**
@@ -760,8 +951,11 @@ class SnomedServices {
       // be valid) from an *unsupported* one (a well-formed expression using a
       // feature this server does not implement). The tx-ecosystem test suite
       // expects INVALID_ECL for the former, UNSUPPORTED_ECL for the latter.
+      // The parser has accepted the expression by now, so an evaluation error
+      // means an unsupported feature - unless it is explicitly about a concept
+      // that does not exist (err.eclInvalid, or the legacy "is not known" text).
       const emsg = (err && err.message) ? err.message : String(err);
-      const invalid = /is not known/.test(emsg) || /Cannot convert .* to a BigInt/i.test(emsg);
+      const invalid = (err && err.eclInvalid) || /is not known/.test(emsg);
       const msgId = invalid ? 'INVALID_ECL' : 'UNSUPPORTED_ECL';
       throw new Issue('error', 'invalid', null, msgId, opContext.i18n.translate(msgId, opContext.langs, [eclExpression, err.message]), 'vs-invalid').handleAsOO(400);
     }
@@ -870,20 +1064,35 @@ class SnomedServices {
     const operator = node.operator; // an ECLTokenType string, or null
     const focus = node.focus;
 
-    // Wildcard
-    if (focus.type === ECLNodeType.WILDCARD) {
-      if (operator) {
-        throw new Error('ECL hierarchy operators combined with wildcard (*) are not supported');
+    // History supplements are parsed but not implemented. Member filters
+    // ({{ M ... }}) are handled in _evalMemberOf; concept filters ({{ C ... }})
+    // and description filters ({{ D ... }}) are applied to the result below.
+    if (node.filters && node.filters.length > 0) {
+      if (node.filters.some(fc => fc.kind === '+')) {
+        throw new Error('ECL history supplements ({{ + ... }}) are not supported');
       }
-      return this._eclWildcard();
+      const inner = { ...node, filters: undefined };
+      let ctx = this._evalSubExpression(inner, opContext);
+      const conceptFilters = node.filters.filter(fc => fc.kind === 'C');
+      if (conceptFilters.length > 0) {
+        ctx = this._applyConceptFilters(ctx, conceptFilters, opContext);
+      }
+      for (const fc of node.filters.filter(fc => fc.kind === 'D')) {
+        ctx = this._applyDescriptionFilter(ctx, fc.filters, opContext);
+      }
+      return ctx;
     }
 
-    // Member-of (^)
-    if (focus.type === ECLNodeType.MEMBER_OF) {
-      if (operator) {
-        throw new Error('ECL hierarchy operators combined with ^ (member-of) are not yet supported');
-      }
-      return this._evalMemberOf(focus, opContext);
+    // Alternate identifiers (ECL 2.1 "scheme#code")
+    if (focus.type === ECLNodeType.ALT_IDENTIFIER) {
+      throw new Error(`ECL alternate identifiers (${focus.scheme}#${focus.code}) are not supported - no alternate identifier reference sets are loaded`);
+    }
+
+    // Top / bottom of set: the members of the focus set with no ancestor
+    // (respectively descendant) in that set
+    if (operator === ECLTokenType.TOP_OF_SET || operator === ECLTokenType.BOTTOM_OF_SET) {
+      const set = this._eclResolveSet(this._evalECLNode(focus, opContext), opContext);
+      return this._eclTopOrBottom(set, operator === ECLTokenType.TOP_OF_SET, opContext);
     }
 
     // Plain concept reference
@@ -891,8 +1100,119 @@ class SnomedServices {
       return this._evalConceptWithOperator(focus.conceptId, operator, opContext);
     }
 
-    // Parenthesised sub-expression: focus is itself a full constraint node
-    return this._evalECLNode(focus, opContext);
+    // Wildcard, member-of, or a parenthesised sub-expression: evaluate the
+    // focus to a set, then apply the operator to each member and union the
+    // results ("< (A OR B)" is "< A OR < B"; "<< ^ refset" is the descendants
+    // of every member). Without an operator the set is the answer.
+    let base;
+    if (focus.type === ECLNodeType.WILDCARD) {
+      base = this._eclWildcard();
+    } else if (focus.type === ECLNodeType.MEMBER_OF) {
+      base = this._evalMemberOf(focus, opContext);
+    } else {
+      base = this._evalECLNode(focus, opContext);
+    }
+    if (!operator) {
+      return base;
+    }
+    return this._eclApplyOperatorToSet(base, operator, opContext);
+  };
+
+  /**
+   * Apply a hierarchy operator to every concept in a set and union the results.
+   * The wildcard is special-cased: its self-inclusive forms are the wildcard
+   * again, and the others are "every concept that has a parent / child".
+   */
+  _eclApplyOperatorToSet = function (ctx, operator, opContext) {
+    if (ctx.eclWildcard && (!ctx.descendants || ctx.descendants.length === 0)) {
+      switch (operator) {
+        case ECLTokenType.DESCENDANT_OR_SELF_OF:
+        case ECLTokenType.ANCESTOR_OR_SELF_OF:
+        case ECLTokenType.CHILD_OR_SELF_OF:
+        case ECLTokenType.PARENT_OR_SELF_OF:
+          return this._eclWildcard();
+        case ECLTokenType.DESCENDANT_OF:
+        case ECLTokenType.CHILD_OF: {
+          const result = new SnomedFilterContext();
+          result.descendants = this._eclEnumerateAllConcepts(opContext).filter(idx => this.getConceptParents(idx).length > 0);
+          return result;
+        }
+        case ECLTokenType.ANCESTOR_OF:
+        case ECLTokenType.PARENT_OF: {
+          const result = new SnomedFilterContext();
+          result.descendants = this._eclEnumerateAllConcepts(opContext).filter(idx => this.getConceptChildren(idx).length > 0);
+          return result;
+        }
+        default:
+          throw new Error(`Unsupported ECL hierarchy operator: ${operator}`);
+      }
+    }
+    const union = new Set();
+    for (const idx of this._eclToIndexArray(ctx)) {
+      if (opContext) opContext.deadCheck('ecl:operatorOnSet');
+      const part = this._evalConceptWithOperator(this.concepts.getConceptId(idx), operator, opContext);
+      for (const r of this._eclToIndexArray(part)) {
+        union.add(r);
+      }
+    }
+    const result = new SnomedFilterContext();
+    result.descendants = [...union];
+    return result;
+  };
+
+  /**
+   * !!> / !!< : keep the concepts in `set` that have no ancestor (top) or no
+   * descendant (bottom) that is also in `set`. Walks the stated parents of each
+   * member within the set, so the cost is bounded by the set's own size.
+   */
+  _eclTopOrBottom = function (set, top, opContext) {
+    const members = new Set(set);
+    // a member is "covered" (not top) when some ancestor is in the set; for
+    // bottom, the ancestor is the one that is covered
+    const covered = new Set();
+    for (const idx of members) {
+      if (opContext) opContext.deadCheck('ecl:topBottom');
+      const seen = new Set();
+      const stack = [...this.getConceptParents(idx)];
+      while (stack.length > 0) {
+        const p = stack.pop();
+        if (seen.has(p)) continue;
+        seen.add(p);
+        if (members.has(p)) {
+          covered.add(top ? idx : p);
+          if (top) break;
+        }
+        stack.push(...this.getConceptParents(p));
+      }
+    }
+    const result = new SnomedFilterContext();
+    result.descendants = [...members].filter(idx => !covered.has(idx));
+    return result;
+  };
+
+  /**
+   * Resolve an attribute name (the left side of a refinement or a dotted step)
+   * to the set of relationship type indexes it denotes: a bare concept gives one
+   * index, `*` any type, and an expression (<< 762705008, (A OR B), ^ refset)
+   * whatever it evaluates to.
+   * @returns {{any: boolean, types: Set<number>|null}}
+   */
+  _eclAttributeTypes = function (nameNode, opContext) {
+    if (nameNode.type === ECLNodeType.WILDCARD) {
+      return { any: true, types: null };
+    }
+    if (nameNode.type === ECLNodeType.CONCEPT_REFERENCE) {
+      const attrResult = this.concepts.findConcept(nameNode.conceptId);
+      if (!attrResult.found) {
+        throw new Error(`The SNOMED CT Concept ${nameNode.conceptId} is not known`);
+      }
+      return { any: false, types: new Set([attrResult.index]) };
+    }
+    const ctx = this._evalECLNode(nameNode, opContext);
+    if (ctx.eclWildcard && (!ctx.descendants || ctx.descendants.length === 0)) {
+      return { any: true, types: null };
+    }
+    return { any: false, types: new Set(this._eclToIndexArray(ctx)) };
   };
 
   /**
@@ -988,12 +1308,21 @@ class SnomedServices {
    * @returns {SnomedFilterContext}
    */
   _evalMemberOf = function (memberOfNode, opContext) {
+    // ^ [field, ...] refset selects which field of the member rows to return
+    // instead of the referenced component. Not supported: the referenced
+    // components, and the fields, may be descriptions or other non-concept
+    // components, which an expansion cannot carry.
+    if (memberOfNode.fields) {
+      throw new Error(`ECL reference set field selection (^ [${memberOfNode.fields.join(', ')}] ...) is not supported`);
+    }
     const refsetConcepts = this._eclResolveSet(this._evalECLNode(memberOfNode.refSet, opContext), opContext);
+    const memberFilters = this._eclPrepareMemberFilters(memberOfNode.memberFilters, opContext);
 
     const members = new Set();
     for (const refsetIdx of refsetConcepts) {
       if (opContext) opContext.deadCheck('ecl:memberOf');
-      const membersRef = this._findRefSetMembersRef(refsetIdx);
+      const refSet = this._findRefSetRecord(refsetIdx);
+      const membersRef = refSet ? refSet.membersByRef : null;
       if (membersRef === null) {
         // Operand concept is not a reference set: yield no members for it
         // (empty result) rather than erroring. Applies to both a bare concept
@@ -1003,15 +1332,21 @@ class SnomedServices {
       if (membersRef === 0 || membersRef === 0xFFFFFFFF) {
         continue; // a reference set with no members
       }
-      const memberList = this.refSetMembers.getMembers(membersRef);
-      for (const m of memberList || []) {
+      const memberList = this.refSetMembers.getMembers(membersRef) || [];
+      // A reference set whose members are descriptions (a language reference
+      // set, say) has no concept members to return. Say so rather than
+      // answering with an empty set, which would read as "no members".
+      if (memberList.length > 0 && !memberList.some(m => m.kind === 0)) {
+        throw new Error(`The members of reference set ${this.concepts.getConceptId(refsetIdx)} are descriptions, not concepts, so ^ cannot be evaluated for it`);
+      }
+      for (const m of memberList) {
         // Concept referenced components only (kind 0). Description/other members
         // are excluded, which also prevents the no-component sentinel (0xFFFFFFFF)
         // from leaking in. The referenced concept may itself be INACTIVE and is
         // still returned — "active" in the spec qualifies the membership row (and
         // inactive rows are already dropped at import), not the referenced
         // concept. The expansion marks/handles inactivity (e.g. activeOnly).
-        if (m.kind === 0) {
+        if (m.kind === 0 && this._eclMemberMatches(m, refSet, memberFilters)) {
           members.add(m.ref);
         }
       }
@@ -1021,6 +1356,380 @@ class SnomedServices {
     return result;
   };
 
+  /**
+   * Apply {{ C ... }} concept filters to a result: each concept is tested on
+   * its own active flag, module, effectiveTime and definition status. Several
+   * filter constraints, and the comma-separated filters within one, all AND.
+   */
+  _applyConceptFilters = function (ctx, filterConstraints, opContext) {
+    const filters = [];
+    for (const fc of filterConstraints) {
+      for (const f of fc.filters) {
+        if (f.valueType === 'expression') {
+          const vctx = this._evalECLNode(f.value, opContext);
+          if (vctx.eclWildcard && (!vctx.descendants || vctx.descendants.length === 0)) {
+            filters.push({ ...f, wildcard: true });
+          } else {
+            filters.push({ ...f, set: new Set(this._eclToIndexArray(vctx)) });
+          }
+        } else {
+          filters.push(f);
+        }
+      }
+    }
+    // The definition status concepts, if this edition has them
+    const statusIndex = (id) => {
+      const r = this.concepts.findConcept(id);
+      return r.found ? r.index : null;
+    };
+    const primitiveIdx = statusIndex('900000000000074008');
+    const definedIdx = statusIndex('900000000000073002');
+
+    const matching = [];
+    for (const idx of this._eclResolveSet(ctx, opContext)) {
+      if (opContext) opContext.deadCheck('ecl:conceptFilter');
+      let ok = true;
+      for (const f of filters) {
+        const field = f.field.toLowerCase();
+        let r;
+        if (field === 'active') {
+          r = this.isActive(idx) === f.value;
+          if (f.operator === '!=') r = !r;
+        } else if (field === 'effectivetime') {
+          const concept = this.concepts.getConcept(idx);
+          r = this._eclCompareValues(this._snomedDateToString(concept.effectiveTime), f.operator, f.values, (a, b) => a.localeCompare(b));
+        } else if (field === 'moduleid') {
+          const inSet = f.wildcard || f.set.has(this.concepts.getModuleId(idx));
+          r = f.operator === '=' ? inSet : !inSet;
+        } else if (field === 'definitionstatusid') {
+          const statusIdx = this.isPrimitive(idx) ? primitiveIdx : definedIdx;
+          const inSet = f.wildcard || (statusIdx !== null && f.set.has(statusIdx));
+          r = f.operator === '=' ? inSet : !inSet;
+        } else if (field === 'definitionstatus') {
+          const status = this.isPrimitive(idx) ? 'primitive' : 'defined';
+          const inSet = f.values.includes(status);
+          r = f.operator === '=' ? inSet : !inSet;
+        } else {
+          throw new Error(`Unsupported concept filter ${f.field}`);
+        }
+        if (!r) {
+          ok = false;
+          break;
+        }
+      }
+      if (ok) {
+        matching.push(idx);
+      }
+    }
+    const result = new SnomedFilterContext();
+    result.descendants = matching;
+    return result;
+  };
+
+  /**
+   * Apply one {{ D ... }} block: a concept is kept when at least one of its
+   * descriptions satisfies every filter in the block. Only active descriptions
+   * are considered unless the block has an `active` filter. Several blocks
+   * AND at the concept level (each may be satisfied by a different description).
+   */
+  _applyDescriptionFilter = function (ctx, filters, opContext) {
+    const K = this._displayConstants();
+    const idx = (id) => { const r = this.concepts.findConcept(id); return r.found ? r.index : -1; };
+    const typeTokens = { syn: K.synonym, fsn: K.fsn, def: idx('900000000000550004') };
+    const acceptabilityIdx = { preferred: K.preferred, acceptable: idx('900000000000549004') };
+    const resolveSet = (expr) => {
+      const vctx = this._evalECLNode(expr, opContext);
+      if (vctx.eclWildcard && (!vctx.descendants || vctx.descendants.length === 0)) return null; // any
+      return new Set(this._eclToIndexArray(vctx));
+    };
+    let activeFilter = null;
+    const prepared = filters.map(f => {
+      const field = f.field.toLowerCase();
+      switch (f.valueType) {
+        case 'term':
+          return { ...f, field, matchers: f.values.map(v => this._eclTermMatcher(v)) };
+        case 'expression':
+          return { ...f, field, set: resolveSet(f.value) };
+        case 'type':
+          return { ...f, field, set: new Set(f.values.map(t => typeTokens[t]).filter(i => i >= 0)) };
+        case 'dialectId':
+        case 'dialect':
+          return { ...f, field, dialects: f.dialects.map(d => {
+            let set;
+            if (d.alias) {
+              const id = ECL_DIALECT_ALIASES[d.alias];
+              if (!id) throw new Error(`Unknown dialect alias ${d.alias} in description filter`);
+              const i = idx(id);
+              set = new Set(i >= 0 ? [i] : []);
+            } else {
+              set = resolveSet(d.expression);
+            }
+            const acceptability = d.acceptability
+              ? new Set(d.acceptability.map(a => acceptabilityIdx[a] !== undefined ? acceptabilityIdx[a] : idx(a)))
+              : null;
+            return { set, acceptability };
+          }) };
+        case 'boolean':
+          activeFilter = f;
+          return { ...f, field };
+        case 'id':
+          return { ...f, field, ids: new Set(f.values.map(v => BigInt(v))) };
+        default:
+          return { ...f, field };
+      }
+    });
+
+    const matching = [];
+    for (const conceptIdx of this._eclResolveSet(ctx, opContext)) {
+      if (opContext) opContext.deadCheck('ecl:descriptionFilter');
+      const concept = this.concepts.getConcept(conceptIdx);
+      const descIndices = concept.descriptions ? (this.refs.getReferences(concept.descriptions) || []) : [];
+      let found = false;
+      for (const descIndex of descIndices) {
+        const d = this.descriptions.getDescription(descIndex);
+        if (!activeFilter && !d.active) continue;
+        if (prepared.every(f => this._eclDescriptionMatches(d, f))) {
+          found = true;
+          break;
+        }
+      }
+      if (found) matching.push(conceptIdx);
+    }
+    const result = new SnomedFilterContext();
+    result.descendants = matching;
+    return result;
+  };
+
+  /**
+   * Does one description satisfy one prepared description filter?
+   */
+  _eclDescriptionMatches = function (d, f) {
+    const neg = f.operator === '!=';
+    const eq = (r) => neg ? !r : r;
+    switch (f.field) {
+      case 'term':
+        return eq(f.matchers.some(m => m(this.strings.getEntry(d.iDesc))));
+      case 'language':
+        return eq(f.values.includes(SCT_LANGUAGE_CODES[d.lang] || 'en'));
+      case 'typeid':
+        return eq(f.set === null || f.set.has(d.kind));
+      case 'type':
+        return eq(f.set.has(d.kind));
+      case 'moduleid':
+        return eq(f.set === null || f.set.has(d.module));
+      case 'dialectid':
+      case 'dialect': {
+        const refsets = d.refsets ? (this.refs.getReferences(d.refsets) || []) : [];
+        const inDialect = f.dialects.some(dl => refsets.some(r => {
+          if (dl.set !== null && !dl.set.has(r)) return false;
+          if (!dl.acceptability) return true;
+          return dl.acceptability.has(this._descAcceptability(d, r));
+        }));
+        return eq(inDialect);
+      }
+      case 'effectivetime':
+        return this._eclCompareValues(this._snomedDateToString(d.date), f.operator, f.values, (a, b) => a.localeCompare(b));
+      case 'active':
+        return eq(d.active === f.value);
+      case 'id':
+        return eq(f.ids.has(d.id));
+      default:
+        throw new Error(`Unsupported description filter ${f.field}`);
+    }
+  };
+
+  /**
+   * A matcher for one typed search term. "match" semantics (the default): every
+   * word of the search term is a prefix of some word of the description, case
+   * insensitively. "wild" semantics: the whole description matches the pattern,
+   * with * standing for any characters.
+   */
+  _eclTermMatcher = function (v) {
+    if (v.kind === 'wild') {
+      const re = new RegExp('^' + v.value.split('*').map(p => p.replace(/[.*+?^${}()|[\]\\]/g, '\\$&')).join('.*') + '$', 'i');
+      return (term) => re.test(term);
+    }
+    const words = v.value.toLowerCase().split(/\s+/).filter(w => w.length > 0);
+    return (term) => {
+      const termWords = term.toLowerCase().split(/[^\p{L}\p{N}]+/u).filter(w => w.length > 0);
+      return words.every(w => termWords.some(tw => tw.startsWith(w)));
+    };
+  };
+
+  /**
+   * Resolve the expression-valued member filters (moduleId = ..., <conceptField> = ...)
+   * once, before the members are walked. Returns the filters with a `set` of
+   * concept indexes attached (or `wildcard: true`), or null when there are none.
+   */
+  _eclPrepareMemberFilters = function (filters, opContext) {
+    if (!filters || filters.length === 0) {
+      return null;
+    }
+    return filters.map(f => {
+      if (f.valueType !== 'expression') {
+        return f;
+      }
+      const ctx = this._evalECLNode(f.value, opContext);
+      if (ctx.eclWildcard && (!ctx.descendants || ctx.descendants.length === 0)) {
+        return { ...f, wildcard: true };
+      }
+      return { ...f, set: new Set(this._eclToIndexArray(ctx)) };
+    });
+  };
+
+  /**
+   * Does a reference set member row satisfy every member filter?
+   *
+   * Member rows are only stored when active, so `active = false` matches
+   * nothing. effectiveTime and moduleId come from the row itself (present when
+   * the reference set stores ids); any other field name is looked up in the
+   * reference set's additional fields (e.g. targetComponentId, mapTarget,
+   * acceptabilityId), typed by the refset file name (c / i / s).
+   */
+  _eclMemberMatches = function (m, refSet, filters) {
+    if (!filters) {
+      return true;
+    }
+    for (const f of filters) {
+      const field = f.field.toLowerCase();
+      let ok;
+      if (field === 'active') {
+        ok = (f.operator === '=') === f.value;
+      } else if (field === 'effectivetime') {
+        if (m.date == null) {
+          return false;
+        }
+        ok = this._eclCompareValues(this._snomedDateToString(m.date), f.operator, f.values, (a, b) => a.localeCompare(b));
+      } else if (field === 'moduleid') {
+        if (m.module == null) {
+          return false;
+        }
+        const inSet = f.wildcard || f.set.has(m.module);
+        ok = f.operator === '=' ? inSet : !inSet;
+      } else {
+        const fv = this._eclMemberFieldValue(m, refSet, f.field);
+        if (fv === undefined) {
+          throw new Error(`Reference set ${this.concepts.getConceptId(refSet.definition)} has no field named ${f.field}`);
+        }
+        if (fv === null) {
+          return false;
+        }
+        switch (f.valueType) {
+          case 'expression': {
+            if (fv.type !== 'concept') {
+              throw new Error(`Reference set field ${f.field} is not a concept field`);
+            }
+            const inSet = f.wildcard || f.set.has(fv.value);
+            ok = f.operator === '=' ? inSet : !inSet;
+            break;
+          }
+          case 'numeric': {
+            if (fv.type !== 'integer') {
+              throw new Error(`Reference set field ${f.field} is not a numeric field`);
+            }
+            ok = this._eclCompareValues(Number(fv.value), f.operator, [Number(f.value)], (a, b) => a - b);
+            break;
+          }
+          case 'string': {
+            if (fv.type !== 'string') {
+              throw new Error(`Reference set field ${f.field} is not a string field`);
+            }
+            ok = this._eclCompareValues(fv.value, f.operator, f.values, (a, b) => a.localeCompare(b));
+            break;
+          }
+          case 'time': {
+            if (fv.type !== 'string') {
+              throw new Error(`Reference set field ${f.field} is not a time field`);
+            }
+            ok = this._eclCompareValues(fv.value, f.operator, f.values, (a, b) => a.localeCompare(b));
+            break;
+          }
+          case 'boolean': {
+            if (fv.type !== 'string' && fv.type !== 'integer') {
+              throw new Error(`Reference set field ${f.field} is not a boolean field`);
+            }
+            const b = String(fv.value) === '1' || String(fv.value).toLowerCase() === 'true';
+            ok = (f.operator === '=') === (b === f.value);
+            break;
+          }
+          default:
+            throw new Error(`Unsupported member filter on ${f.field}`);
+        }
+      }
+      if (!ok) {
+        return false;
+      }
+    }
+    return true;
+  };
+
+  /**
+   * Compare one value against a value set with an ECL comparison operator.
+   * "=" is true when any set value matches, "!=" when none does; the ordering
+   * operators compare against the single value.
+   */
+  _eclCompareValues = function (actual, operator, values, cmp) {
+    switch (operator) {
+      case '=': return values.some(v => cmp(actual, v) === 0);
+      case '!=': return !values.some(v => cmp(actual, v) === 0);
+      case '<': return cmp(actual, values[0]) < 0;
+      case '<=': return cmp(actual, values[0]) <= 0;
+      case '>': return cmp(actual, values[0]) > 0;
+      case '>=': return cmp(actual, values[0]) >= 0;
+      default: throw new Error(`Unsupported comparison operator ${operator}`);
+    }
+  };
+
+  /**
+   * Read a named additional field from a member row. Returns undefined when the
+   * reference set has no such field, null when the row has no value for it, and
+   * otherwise { type: 'concept'|'description'|'integer'|'string', value }.
+   */
+  _eclMemberFieldValue = function (m, refSet, fieldName) {
+    if (!refSet.fieldNames) {
+      return undefined;
+    }
+    const names = this.refs.getReferences(refSet.fieldNames) || [];
+    const idx = names.findIndex(n => this.strings.getEntry(n).trim().toLowerCase() === fieldName.toLowerCase());
+    if (idx < 0) {
+      return undefined;
+    }
+    const values = m.values ? this.refs.getReferences(m.values) : null;
+    if (!values || values.length < (idx + 1) * 2) {
+      return null;
+    }
+    const value = values[idx * 2];
+    const type = values[idx * 2 + 1];
+    switch (type) {
+      case 1: return { type: 'concept', value };
+      case 2: return { type: 'description', value };
+      case 4: return { type: 'integer', value };
+      case 5: return { type: 'string', value: this.strings.getEntry(value) };
+      default: return null;
+    }
+  };
+
+  /**
+   * Stored SNOMED dates are days since the Pascal TDateTime epoch (1899-12-30);
+   * render as YYYYMMDD for comparison with an ECL time value.
+   */
+  _snomedDateToString = function (days) {
+    const d = new Date(Date.UTC(1899, 11, 30) + days * 86400000);
+    return d.toISOString().slice(0, 10).replace(/-/g, '');
+  };
+
+  _findRefSetRecord = function (conceptIndex) {
+    for (let i = 0; i < this.refSetIndex.count(); i++) {
+      const refSet = this.refSetIndex.getReferenceSet(i);
+      // definition 0 means the importer could not resolve the reference set's
+      // concept (it is outside the subset) - not "the concept at offset 0"
+      if (refSet.definition === conceptIndex && refSet.definition !== 0) {
+        return refSet;
+      }
+    }
+    return null;
+  };
+
   /**
    * Wildcard — every concept, active or not.  The eclWildcard flag tells filterCheck /
    * filterLocate to accept every active concept without enumeration.
@@ -1046,14 +1755,7 @@ class SnomedServices {
     let current = this._eclResolveSet(this._evalECLNode(node.base, opContext), opContext);
 
     for (const attr of node.attributes || []) {
-      if (attr.type !== ECLNodeType.CONCEPT_REFERENCE) {
-        throw new Error('ECL dotted expressions only support plain concept-reference attribute names');
-      }
-      const attrResult = this.concepts.findConcept(attr.conceptId);
-      if (!attrResult.found) {
-        throw new Error(`The SNOMED CT Concept ${attr.conceptId} is not known`);
-      }
-      const attrTypeIdx = attrResult.index;
+      const types = this._eclAttributeTypes(attr, opContext);
 
       const next = new Set();
       for (const conceptIdx of current) {
@@ -1061,7 +1763,7 @@ class SnomedServices {
         const relIdxs = this.getConceptRelationships(conceptIdx);
         for (const relIdx of relIdxs) {
           const rel = this.relationships.getRelationship(relIdx);
-          if (rel.active && rel.relType === attrTypeIdx) {
+          if (rel.active && (types.any || types.types.has(rel.relType))) {
             next.add(rel.target);
           }
         }
@@ -1080,7 +1782,7 @@ class SnomedServices {
    * Evaluate a refined expression: `<baseConstraint> : <refinement>`.
    * Supported refinement shapes:
    *   - ATTRIBUTE            attr = valueExpr
-   *   - ATTRIBUTE_SET        attr1 = v1, attr2 = v2 (conjunction)
+   *   - ATTRIBUTE_SET        attr1 = v1, attr2 = v2 / attr1 = v1 AND|OR attr2 = v2 (operator 'AND'|'OR')
    *   - ATTRIBUTE_GROUP      { attr1 = v1, attr2 = v2 } (same relationship group)
    * Reverse attributes, cardinality, `!=`, and non-concept attribute names
    * throw informative errors.
@@ -1113,10 +1815,11 @@ class SnomedServices {
       case ECLNodeType.ATTRIBUTE:
         return this._attributeMatches(rels, refinement, null, opContext);
       case ECLNodeType.ATTRIBUTE_SET:
-        for (const a of refinement.attributes) {
-          if (!this._refinementMatches(rels, a, opContext)) return false;
+        // operator is 'AND' (also for ",") or 'OR'
+        if (refinement.operator === 'OR') {
+          return refinement.attributes.some(a => this._refinementMatches(rels, a, opContext));
         }
-        return true;
+        return refinement.attributes.every(a => this._refinementMatches(rels, a, opContext));
       case ECLNodeType.ATTRIBUTE_GROUP:
         return this._attributeGroupMatches(rels, refinement, opContext);
       default:
@@ -1124,6 +1827,23 @@ class SnomedServices {
     }
   };
 
+  /**
+   * The same, restricted to the relationships in one role group: an attribute
+   * set inside { } may itself be an AND/OR tree of attributes.
+   */
+  _refinementMatchesInGroup = function (rels, node, g, opContext) {
+    if (node.type === ECLNodeType.ATTRIBUTE_SET) {
+      if (node.operator === 'OR') {
+        return node.attributes.some(a => this._refinementMatchesInGroup(rels, a, g, opContext));
+      }
+      return node.attributes.every(a => this._refinementMatchesInGroup(rels, a, g, opContext));
+    }
+    if (node.type !== ECLNodeType.ATTRIBUTE) {
+      throw new Error(`Unsupported node type in attribute group: ${node.type}`);
+    }
+    return this._attributeMatches(rels, node, g, opContext);
+  };
+
   /**
    * Check whether a concept has at least one active relationship whose
    * `relType` matches the attribute name and whose `target` is in the value
@@ -1142,14 +1862,11 @@ class SnomedServices {
       throw new Error('ECL attribute without a comparison is not supported');
     }
     if (attr.comparison.type !== ECLNodeType.EXPRESSION_COMPARISON) {
-      throw new Error(`ECL ${attr.comparison.type} in refinements is not yet supported`);
+      throw new Error('ECL concrete values (numeric, string and boolean attribute values) are not supported - concrete value relationships are not loaded');
     }
     if (attr.comparison.operator !== ECLTokenType.EQUALS) {
       throw new Error('ECL != in refinements is not yet supported');
     }
-    if (attr.name.type !== ECLNodeType.CONCEPT_REFERENCE) {
-      throw new Error('ECL refinements only support plain concept-reference attribute names');
-    }
 
     const count = this._countAttributeMatches(rels, attr, groupFilter, opContext);
 
@@ -1178,17 +1895,13 @@ class SnomedServices {
     // fresh per request, so memoising on the node is safe within a request.
     let resolved = attr._eclResolved;
     if (!resolved) {
-      const attrResult = this.concepts.findConcept(attr.name.conceptId);
-      if (!attrResult.found) {
-        throw new Error(`The SNOMED CT Concept ${attr.name.conceptId} is not known`);
-      }
       resolved = {
-        attrTypeIdx: attrResult.index,
+        types: this._eclAttributeTypes(attr.name, opContext),
         valueSet: new Set(this._eclResolveSet(this._evalECLNode(attr.comparison.value, opContext), opContext))
       };
       attr._eclResolved = resolved;
     }
-    const attrTypeIdx = resolved.attrTypeIdx;
+    const types = resolved.types;
     const valueSet = resolved.valueSet;
 
     // ECL cardinality counts OCCURRENCES of a matching attribute, per role group
@@ -1203,7 +1916,7 @@ class SnomedServices {
     for (const rel of rels) {
       if (opContext) opContext.deadCheck('ecl:countAttributeMatches');
       if (!rel.active) continue;
-      if (rel.relType !== attrTypeIdx) continue;
+      if (!types.any && !types.types.has(rel.relType)) continue;
       if (groupFilter !== null && rel.group !== groupFilter) continue;
       if (valueSet.has(rel.target)) matched.add(rel.group + ':' + rel.target);
     }
@@ -1248,7 +1961,7 @@ class SnomedServices {
       if (opContext) opContext.deadCheck('ecl:attributeGroup');
       let allMatch = true;
       for (const attr of group.attributes) {
-        if (!this._attributeMatches(rels, attr, g, opContext)) {
+        if (!this._refinementMatchesInGroup(rels, attr, g, opContext)) {
           allMatch = false;
           break;
         }
@@ -1690,6 +2403,15 @@ class SnomedProvider extends BaseCSServices {
     return this.sct.getDescription();
   }
 
+  /**
+   * $lookup's display name: the edition description (e.g. "SNOMED CT International
+   * Edition"), which says more than the bare code system title.
+   */
+  // eslint-disable-next-line no-unused-vars
+  lookupName(languages) {
+    return this.sct.getDescription();
+  }
+
   description() {
     return this.sct.getDescription();
   }
@@ -2038,34 +2760,46 @@ class SnomedProvider extends BaseCSServices {
     const ctxt = await this.#ensureContext(context);
     if (ctxt) {
       if (!(ctxt instanceof SnomedExpressionContext) || ctxt.expression?.concepts.length == 1) {
-        const time = this.sct.concepts.getConcept(ctxt.getReference()).effectiveTime;
-        // Pascal TDateTime epoch (1899-12-30) computed in UTC so the formatted
-        // date is timezone-independent. new Date(1899,11,30) is LOCAL midnight,
-        // which in zones ahead of UTC rolls the ISO date back by one day.
-        const pascalEpochUTC = Date.UTC(1899, 11, 30);
-        const date = new Date(pascalEpochUTC + time * 86400000);
-        const dateStr = date.toISOString().slice(0, 10);
-        this._addDateTimeProperty(params, 'property', 'effectiveTime', dateStr);
-
+        // Only what was asked for, if anything was (see _hasProp): effectiveTime, module,
+        // parent, child and the defining relationships are returned by default but are not
+        // important enough to return when the client named the properties it wants.
+        // The mappings (alternate identifiers such as the LOINC code) are returned by
+        // default too, and when asked for by name.
+        if (this._hasProp(props, 'effectiveTime', true)) {
+          const time = this.sct.concepts.getConcept(ctxt.getReference()).effectiveTime;
+          // Pascal TDateTime epoch (1899-12-30) computed in UTC so the formatted
+          // date is timezone-independent. new Date(1899,11,30) is LOCAL midnight,
+          // which in zones ahead of UTC rolls the ISO date back by one day.
+          const pascalEpochUTC = Date.UTC(1899, 11, 30);
+          const date = new Date(pascalEpochUTC + time * 86400000);
+          const dateStr = date.toISOString().slice(0, 10);
+          this._addDateTimeProperty(params, 'property', 'effectiveTime', dateStr);
+        }
 
-        const parents = this.sct.getConceptParents(ctxt.getReference());
-        for (let parentRef of parents) {
-          const code = this.sct.getConceptId(parentRef);
-          const description = this.sct.getDisplayName(parentRef);
-          this._addCodeProperty(params, 'property', 'parent', code, null, description);
+        if (this._hasProp(props, 'parent', true)) {
+          const parents = this.sct.getConceptParents(ctxt.getReference());
+          for (let parentRef of parents) {
+            const code = this.sct.getConceptId(parentRef);
+            const description = this.sct.getDisplayName(parentRef);
+            this._addCodeProperty(params, 'property', 'parent', code, null, description);
+          }
         }
 
-        const children = this.sct.getConceptChildren(ctxt.getReference());
-        for (let childRef of children) {
-          const code = this.sct.getConceptId(childRef);
-          const description = this.sct.getDisplayName(childRef);
-          this._addCodeProperty(params, 'property', 'child', code, null, description);
+        if (this._hasProp(props, 'child', true)) {
+          const children = this.sct.getConceptChildren(ctxt.getReference());
+          for (let childRef of children) {
+            const code = this.sct.getConceptId(childRef);
+            const description = this.sct.getDisplayName(childRef);
+            this._addCodeProperty(params, 'property', 'child', code, null, description);
+          }
         }
 
-        const moduleId = this.sct.concepts.getModuleId(ctxt.getReference());
-        if (moduleId) {
-          const code = this.sct.getConceptId(moduleId);
-          this._addCodeProperty(params, 'property', 'module', code, null, this.sct.getDisplayName(moduleId));
+        if (this._hasProp(props, 'module', true)) {
+          const moduleId = this.sct.concepts.getModuleId(ctxt.getReference());
+          if (moduleId) {
+            const code = this.sct.getConceptId(moduleId);
+            this._addCodeProperty(params, 'property', 'module', code, null, this.sct.getDisplayName(moduleId));
+          }
         }
 
         const relationships = this.sct.getConceptRelationships(ctxt.getReference());
@@ -2073,7 +2807,7 @@ class SnomedProvider extends BaseCSServices {
         for (let relationshipRef of relationships) {
           const relationship = this.sct.relationships.getRelationship(relationshipRef);
           const relType = this.sct.getConceptId(relationship.relType);
-          if (relType != '116680003') {
+          if (relType != '116680003' && this._hasProp(props, relType, true)) {
             const relTypeD = this.sct.getDisplayName(relationship.relType);
             const code = this.sct.getConceptId(relationship.target);
             const description = this.sct.getDisplayName(relationship.target);
@@ -2084,6 +2818,8 @@ class SnomedProvider extends BaseCSServices {
             }
           }
         }
+
+        this.#addMappingProperties(ctxt, props, params);
       }
       if (ctxt instanceof SnomedExpressionContext) {
         // ignore concepts for now, but list refinements and refinement groups
@@ -2099,6 +2835,27 @@ class SnomedProvider extends BaseCSServices {
     }
   }
 
+  /**
+   * The concept's alternate identifiers in the schemes we know (IDENTIFIER_SCHEMES), as
+   * Coding-valued properties named for the scheme - e.g. loinc = http://loinc.org#2160-0.
+   * Returned by default, and when asked for by name.
+   */
+  #addMappingProperties(ctxt, props, params) {
+    const conceptId = this.sct.getConceptId(ctxt.getReference());
+    for (const ident of this.sct.getIdentifiers(conceptId)) {
+      const scheme = IDENTIFIER_SCHEMES[ident.scheme];
+      if (scheme && this._hasProp(props, scheme.property, true)) {
+        params.push({
+          name: 'property',
+          part: [
+            { name: 'code', valueCode: scheme.property },
+            { name: 'value', valueCoding: { system: scheme.system, code: ident.code } }
+          ]
+        });
+      }
+    }
+  }
+
   /**
    * Report one refinement of a post-coordinated expression as a lookup property.
    *
@@ -2154,6 +2911,11 @@ class SnomedProvider extends BaseCSServices {
       return true;
     }
 
+    if (prop.startsWith(MAPPED_FILTER_PREFIX)) {
+      return op === 'exists' && ['true', 'false'].includes(value) &&
+        this.sct.stringToIdOrZero(prop.substring(MAPPED_FILTER_PREFIX.length)) !== 0n;
+    }
+
     const cid = this.sct.stringToIdOrZero(prop);
     if (cid != 0) {
       const id = this.sct.stringToIdOrZero(value);
@@ -2310,6 +3072,27 @@ class SnomedProvider extends BaseCSServices {
       return null;
     }
 
+    // mapped:<identifier scheme> exists true|false - concepts that do (or don't) have an
+    // alternate identifier in that scheme (e.g. mapped:30051010000102: has a LOINC code).
+    // A prefix, so as not to be confused with the attribute filters (<attribute> = <value>)
+    if (prop.startsWith(MAPPED_FILTER_PREFIX)) {
+      const scheme = prop.substring(MAPPED_FILTER_PREFIX.length);
+      if (this.sct.stringToIdOrZero(scheme) === 0n) {
+        throw new Error(`Invalid identifier scheme: ${scheme}`);
+      }
+      if (op !== 'exists') {
+        throw new Error(`Unsupported filter operation: ${prop} ${op} ${value}`);
+      }
+      if (value !== 'true' && value !== 'false') {
+        throw new Error(`Invalid filter value: ${value}`);
+      }
+      const filter = new SnomedFilterContext();
+      filter.mappedScheme = scheme;
+      filter.mappedExists = value === 'true';
+      filterContext.filters.push(filter);
+      return null;
+    }
+
     const cid = this.sct.stringToIdOrZero(prop);
     if (cid != 0) {
 
@@ -2413,7 +3196,9 @@ class SnomedProvider extends BaseCSServices {
     }
     let found = false;
 
-    if (set.inactive !== undefined) {
+    if (set.mappedScheme !== undefined) {
+      found = this.#isMapped(reference, set.mappedScheme) === set.mappedExists;
+    } else if (set.inactive !== undefined) {
       let concept = this.sct.concepts.getConcept(reference);
       let active = (concept.flags & 0x0F) === 0;
       found = active !== set.inactive
@@ -2459,6 +3244,9 @@ class SnomedProvider extends BaseCSServices {
     }
 
     const reference = concept.getReference();
+    if (set.mappedScheme !== undefined) {
+      return this.#isMapped(reference, set.mappedScheme) === set.mappedExists;
+    }
     if (set.inactive !== undefined) {
       return this.sct.isActive(reference) !== set.inactive;
     }
@@ -2518,10 +3306,39 @@ class SnomedProvider extends BaseCSServices {
     return set._matchSet.has(reference);
   }
 
+  /** Whether the concept (by reference) has an alternate identifier in the scheme */
+  #isMapped(reference, scheme) {
+    return this.sct.getIdentifiers(this.sct.getConceptId(reference), scheme).length > 0;
+  }
+
   #ensurePopulated(set) {
     if (set.populationDone) {
       return;
     }
+    if (set.mappedScheme !== undefined) {
+      if (set.mappedExists) {
+        // straight from the identifier index, in concept order
+        const refs = new Set();
+        for (const [conceptId, idents] of this.sct.identifiersByConcept) {
+          if (idents.some(i => i.scheme === set.mappedScheme)) {
+            const r = this.sct.concepts.findConcept(BigInt(conceptId));
+            if (r.found) {
+              refs.add(r.index);
+            }
+          }
+        }
+        set.descendants = [...refs].sort((a, b) => a - b);
+      } else {
+        for (let i = 0; i < this.sct.concepts.count(); i++) {
+          const concept = this.sct.concepts.getConceptByCount(i);
+          if (!this.#isMapped(concept.index, set.mappedScheme)) {
+            set.descendants.push(concept.index);
+          }
+        }
+      }
+      set.populationDone = true;
+      return;
+    }
     if (set.inactive !== undefined && set.descendants.length === 0) {
       for (let i = 0; i < this.sct.concepts.count(); i++) {
         let concept = this.sct.concepts.getConceptByCount(i);
@@ -2673,7 +3490,16 @@ class SnomedProvider extends BaseCSServices {
   }
 
   async getTranslations(map, coding, target, reverse) {
-    if (!map || (target && target !== this.system()) || reverse) {
+    if (map && map.jsonObj.identifierMap) {
+      return this.translateByIdentifier(map, coding, target);
+    }
+    if (!map || reverse) {
+      return [];
+    }
+    if (map.jsonObj.editionTranslation) {
+      return this.translateToEdition(map, coding);
+    }
+    if (target && target !== this.system()) {
       return [];
     }
     let ref = this.sct.concepts.findConcept(map.id);
@@ -2730,6 +3556,181 @@ class SnomedProvider extends BaseCSServices {
     return result;
   }
 
+  /**
+   * Translate using a module's alternate identifiers (the implicit map ?fhir_cm=<module>,
+   * e.g. the LOINC Extension's LOINC codes). The identifiers say the concept and the code
+   * are the same thing, so the map works the same in both directions: a SNOMED CT concept
+   * translates to its codes, and a code in the identifier's system to its concepts. Either
+   * way the relationship is equivalent.
+   */
+  async translateByIdentifier(map, coding, target) {
+    const { schemes } = map.jsonObj.identifierMap;
+    const targetSystem = target ? target.split('|')[0] : null;
+    const result = [];
+    if (coding.system === this.system()) {
+      const ctxt = await this.locate(coding.code);
+      if (!ctxt.context) {
+        return [];
+      }
+      const conceptId = this.sct.getConceptId(ctxt.context.getReference());
+      for (const ident of this.sct.getIdentifiers(conceptId)) {
+        const scheme = IDENTIFIER_SCHEMES[ident.scheme];
+        if (scheme && schemes.includes(ident.scheme) && (!targetSystem || targetSystem === scheme.system)) {
+          result.push({
+            map: map.vurl,
+            system: scheme.system,
+            code: ident.code,
+            relationship: 'equivalent'
+          });
+        }
+      }
+    } else if (!targetSystem || targetSystem === this.system()) {
+      for (const schemeId of schemes) {
+        const scheme = IDENTIFIER_SCHEMES[schemeId];
+        if (scheme && scheme.system === coding.system) {
+          for (const conceptId of this.sct.getConceptsForIdentifier(schemeId, coding.code)) {
+            result.push({
+              map: map.vurl,
+              system: this.system(),
+              version: this.version(),
+              code: conceptId,
+              display: await this.display(conceptId),
+              relationship: 'equivalent'
+            });
+          }
+        }
+      }
+    }
+    return result;
+  }
+
+  /**
+   * Translate a concept of this edition to the edition it depends on (typically a national
+   * extension to the International Edition). There is no map: the answer comes from the
+   * definitions.
+   *  - a concept in one of the target edition's modules is its own translation
+   *  - an inactive concept translates via its historical associations (REPLACED BY, SAME AS,
+   *    POSSIBLY EQUIVALENT TO, ALTERNATIVE) to concepts in the target edition
+   *  - a fully defined extension concept translates to its normal form, provided every concept
+   *    in it belongs to the target edition; if the target edition has a concept with that same
+   *    normal form, to that concept
+   *  - otherwise (a primitive extension concept, or a definition that uses other extension
+   *    content) to its proximal ancestors in the target edition, which it is narrower than -
+   *    unless the only such ancestors are top-level hierarchies (or the root), which carry no
+   *    information: that is reported as a reason rather than a translation
+   */
+  async translateToEdition(map, coding) {
+    const ed = map.jsonObj.editionTranslation;
+    const sct = this.sct;
+    const src = sct.concepts.findConcept(coding.code);
+    if (!src.found) {
+      return [];
+    }
+    const inTarget = (ref) => ed.modules.has(sct.concepts.getModuleId(ref));
+    const mk = (code, display, relationship) => ({
+      map: map.vurl, system: this.system(), version: ed.version, code, display, relationship
+    });
+    const named = (ref) => `${sct.getConceptId(ref)} |${sct.getDisplayName(ref, sct.defaultLanguage)}|`;
+
+    if (inTarget(src.index)) {
+      return [mk(sct.getConceptId(src.index), sct.getDisplayName(src.index, sct.defaultLanguage), 'equivalent')];
+    }
+
+    if (!sct.isActive(src.index)) {
+      const result = [];
+      for (const [refset, relationship] of [['900000000000527005', 'equivalent'], ['900000000000526001', 'equivalent'],
+        ['900000000000523009', 'related-to'], ['900000000000530003', 'related-to']]) {
+        for (const tgt of this.#historicalAssociations(refset, src.index)) {
+          if (inTarget(tgt)) {
+            result.push(mk(sct.getConceptId(tgt), sct.getDisplayName(tgt, sct.defaultLanguage), relationship));
+          }
+        }
+      }
+      return result;
+    }
+
+    if (!sct.isPrimitive(src.index)) {
+      const nf = sct.expressionServices.createNormalForm(src.index);
+      if (this.#expressionConcepts(nf).every(inTarget)) {
+        const same = sct.conceptWithNormalForm(sct.expressionServices.renderExpression(nf, SnomedServicesRenderOption.Minimal));
+        if (same >= 0 && same !== src.index && inTarget(same)) {
+          return [mk(sct.getConceptId(same), sct.getDisplayName(same, sct.defaultLanguage), 'equivalent')];
+        }
+        // the canonical form self-groups every attribute; for output, never-grouped ones go back ungrouped
+        const out = sct.expressionServices.ungroupNeverGroupedRefinements(nf);
+        return [mk(sct.expressionServices.renderExpression(out, SnomedServicesRenderOption.Minimal),
+          sct.expressionServices.renderExpression(out, SnomedServicesRenderOption.FillMissing), 'equivalent')];
+      }
+    }
+
+    const ancestors = this.#proximalAncestorsIn(src.index, inTarget);
+    if (ancestors.length === 0) {
+      return [];
+    }
+    const useful = ancestors.filter(a => sct.concepts.getDepth(a) >= 2);
+    if (useful.length === 0) {
+      const list = ancestors.map(named);
+      const msgId = list.length === 1 ? 'TRANSLATE_SCT_EDITION_TOP_LEVEL_ONE' : 'TRANSLATE_SCT_EDITION_TOP_LEVEL_MANY';
+      return [{ message: this.opContext.i18n.translate(msgId, this.opContext.langs,
+        [getEditionName(ed.moduleId), named(src.index), list.join(', ')]) }];
+    }
+    return useful.map(a => mk(sct.getConceptId(a), sct.getDisplayName(a, sct.defaultLanguage), 'source-is-narrower-than-target'));
+  }
+
+  /** The target components of the given association reference set for a concept */
+  #historicalAssociations(refsetId, conceptIndex) {
+    const sct = this.sct;
+    const rs = sct.concepts.findConcept(refsetId);
+    if (!rs.found) return [];
+    const rref = sct.refSetIndex.getRefSetByConcept(rs.index);
+    if (rref === -1) return [];
+    const members = sct.refSetMembers.getMembers(sct.refSetIndex.getReferenceSet(rref).membersByRef);
+    const result = [];
+    for (const m of members) {
+      if (m.ref !== conceptIndex) continue;
+      const values = m.values ? sct.refs.getReferences(m.values) : null;
+      if (values && values.length >= 1 && values[0]) {
+        result.push(values[0]);
+      }
+    }
+    return result;
+  }
+
+  /** Every concept reference used anywhere in an expression */
+  #expressionConcepts(exp, into = []) {
+    for (const c of exp.concepts) {
+      if (c.reference !== NO_REFERENCE) into.push(c.reference);
+    }
+    const refinements = [...exp.refinements, ...exp.refinementGroups.flatMap(g => g.refinements)];
+    for (const r of refinements) {
+      if (r.name && r.name.reference !== NO_REFERENCE) into.push(r.name.reference);
+      if (r.value) this.#expressionConcepts(r.value, into);
+    }
+    return into;
+  }
+
+  /**
+   * The nearest ancestors of a concept that satisfy the test: a parent that does is taken
+   * and not looked beyond; one that does not is replaced by its own parents.
+   */
+  #proximalAncestorsIn(conceptIndex, test) {
+    const result = [];
+    const seen = new Set();
+    const todo = [...this.sct.expressionServices.getConceptParents(conceptIndex)];
+    while (todo.length) {
+      const p = todo.shift();
+      if (seen.has(p)) continue;
+      seen.add(p);
+      if (test(p)) {
+        result.push(p);
+      } else {
+        todo.push(...this.sct.expressionServices.getConceptParents(p));
+      }
+    }
+    // an ancestor that is itself subsumed by another in the list is not proximal
+    return result.filter(a => !result.some(b => b !== a && this.sct.subsumes(a, b)));
+  }
+
   hasMultiHierarchy() {
     return true;
   }
@@ -2979,11 +3980,140 @@ class SnomedServicesFactory extends CodeSystemFactoryProvider {
     return edition + ' ' + formatDateMMDDYYYY(match[2].substring(4, 6) + match[2].substring(6, 8) + match[2].substring(0, 4));
   }
 
+  /**
+   * A translation from this edition to an edition it depends on needs no map: the answer
+   * comes from the definitions (see SnomedProvider.translateToEdition). The request names
+   * the source by its edition URI (with or without a version) and the target as
+   * system|edition URI (with or without a version); the map's url is the versioned source
+   * edition URI plus ?fhir_cm=edition/<target edition module>
+   */
+  async findImplicitConceptMaps(conceptMaps, source, sourceVersion, dest) {
+    if (dest) {
+      this.#findIdentifierMaps(conceptMaps, source, sourceVersion, dest);
+    }
+    if (source !== this.system() || !sourceVersion || !dest || !this.isMyEdition(sourceVersion)) {
+      return;
+    }
+    const bar = dest.indexOf('|');
+    if (bar === -1 || dest.substring(0, bar) !== this.system()) {
+      return;
+    }
+    const dep = this.snomedServices.editionDependency(dest.substring(bar + 1));
+    if (dep) {
+      conceptMaps.push(this.editionTranslationMap(dep));
+    }
+  }
+
+  /**
+   * The implicit map from this edition to an edition it depends on. Its url is the one
+   * agreed with SNOMED International: <source edition>/version/<date>?fhir_cm=edition/<target module>
+   * (the source always versioned, whatever the request said)
+   */
+  editionTranslationMap(dep) {
+    return new ConceptMap({
+      resourceType: 'ConceptMap',
+      internalSource: this,
+      editionTranslation: dep,
+      url: `${this.version()}?fhir_cm=edition/${dep.moduleId}`,
+      name: `SNOMED CT ${this.describeVersion(this.version())} to ${getEditionName(dep.moduleId)} Concept Map`,
+      description: `The translation implied by the concept definitions of the edition ${this.version()} to the ${getEditionName(dep.moduleId)} that it depends on`,
+      status: 'active',
+      group: [{
+        source: this.system(),
+        target: this.system()
+      }]
+    });
+  }
+
+  /**
+   * Maps implied by alternate identifiers, found from the systems rather than nominated:
+   * from this edition (source system|version naming it) to an identifier system (LOINC,
+   * say), or from an identifier system to this edition (the target given as
+   * system|edition URI, with or without the version)
+   */
+  #findIdentifierMaps(conceptMaps, source, sourceVersion, dest) {
+    const bar = dest.indexOf('|');
+    const destSystem = bar === -1 ? dest : dest.substring(0, bar);
+    const destVersion = bar === -1 ? null : dest.substring(bar + 1);
+    let identSystem;
+    if (source === this.system() && sourceVersion && this.isMyEdition(sourceVersion)) {
+      identSystem = destSystem;
+    } else if (destSystem === this.system() && destVersion && this.isMyEdition(destVersion)) {
+      identSystem = source;
+    } else {
+      return;
+    }
+    for (const [moduleId, schemes] of this.snomedServices.identifierModules) {
+      if ([...schemes].some(s => IDENTIFIER_SCHEMES[s] && IDENTIFIER_SCHEMES[s].system === identSystem)) {
+        const cm = this.identifierMap(moduleId);
+        if (cm && !conceptMaps.some(m => m.url === cm.url)) {
+          conceptMaps.push(cm);
+        }
+      }
+    }
+  }
+
+  /**
+   * The implicit map defined by a module's alternate identifiers, if the module has any
+   * in a scheme we know. Its url follows the edition maps: <source edition>/version/<date>?fhir_cm=<module>
+   */
+  identifierMap(moduleId) {
+    const schemes = [...(this.snomedServices.identifierModules.get(moduleId) || [])].filter(s => IDENTIFIER_SCHEMES[s]);
+    if (schemes.length === 0) {
+      return null;
+    }
+    const systems = schemes.map(s => IDENTIFIER_SCHEMES[s].system);
+    const moduleName = this.snomedServices.conceptExists(moduleId)
+      ? this.snomedServices.getDisplayName(this.snomedServices.concepts.findConcept(BigInt(moduleId)).index) : moduleId;
+    return new ConceptMap({
+      resourceType: 'ConceptMap',
+      internalSource: this,
+      identifierMap: { module: moduleId, schemes: schemes },
+      url: `${this.version()}?fhir_cm=${moduleId}`,
+      name: `SNOMED CT ${moduleName} Concept Map`,
+      description: `The concept map implied by the alternate identifiers (${systems.join(', ')}) of the module ${moduleId} |${moduleName}| in ${this.version()}`,
+      status: 'active',
+      group: [
+        ...systems.map(s => ({ source: this.system(), target: s })),
+        ...systems.map(s => ({ source: s, target: this.system() }))
+      ]
+    });
+  }
+
+  /** Whether a source version names this edition: exactly, or the edition without a version */
+  isMyEdition(version) {
+    const mine = this.version();
+    return version === mine || mine.startsWith(version + '/version/');
+  }
+
   async findImplicitConceptMap(url, version) {
     if (version && (version !== this.version())) {
       return null;
     }
-    if (!url || !url.startsWith(this.system()+"?fhir_cm=")) {
+    if (!url) {
+      return null;
+    }
+    // <edition[/version/date]>?fhir_cm=edition/<module>: this edition's definition-based
+    // translation to an edition it depends on, nominated by url
+    const q = url.indexOf('?fhir_cm=edition/');
+    if (q !== -1) {
+      if (!this.isMyEdition(url.substring(0, q))) {
+        return null;
+      }
+      const dep = this.snomedServices.editionDependency(`http://snomed.info/sct/${url.substring(q + '?fhir_cm=edition/'.length)}`);
+      return dep ? this.editionTranslationMap(dep) : null;
+    }
+    // <edition[/version/date]>?fhir_cm=<module>: the map implied by a module's alternate
+    // identifiers (e.g. 11010000107, the LOINC Extension's LOINC codes)
+    const qm = url.indexOf('?fhir_cm=');
+    if (qm !== -1 && url.substring(0, qm) !== this.system()) {
+      if (!this.isMyEdition(url.substring(0, qm))) {
+        return null;
+      }
+      await this.#ensureLoaded();
+      return this.identifierMap(url.substring(qm + '?fhir_cm='.length));
+    }
+    if (!url.startsWith(this.system()+"?fhir_cm=")) {
       return null;
     }
     let id = url.substring(url.indexOf("=")+1);