Core Concepts

@cosyte/terminology is a terminology engine, not a wire-format parser. It mirrors the FHIR Terminology Module - the industry's own architecture for keeping terminology a swappable service separate from the data that uses it - so its operations ($translate, $lookup, $validate-code, ValueSet $expand / binding, UCUM unit validation, and the published crosswalk resolvers) speak the FHIR shape every downstream tool already understands.

Bring-your-own data, engine-only

The engine ships no code-system release. You feed it standard FHIR resources - a ConceptMap, and later a CodeSystem/ValueSet - and it answers questions over them. SNOMED CT, CPT, LOINC, the UMLS/RxNorm release, and VSAC value sets are strictly consumer-supplied (a licensing wall, not a feature gap). What is bundled, named with its copyright, includes the UCUM unit table (copyright ©1999–2024 Regenstrief Institute, Inc., verbatim under https://ucum.org/license; notice shipped at vendor/ucum/NOTICE.md), the SNOMED CT concepts the crosswalk resolver names - the map-category concepts and the two gender findings (SNOMED CT is copyright © International Health Terminology Standards Development Organisation) - the code-system identities, the OID ↔ canonical-URI ↔ mnemonic pairings, which identify the systems rather than listing any system's codes, and RxNorm's relationship and term-type names (RELA, RELA_INVERSE, TERM_TYPES), published by the U.S. National Library of Medicine. Individual SNOMED CT, ICD-10-CM and RxNorm identifiers also appear in the API documentation examples. The full list is in the package's LICENSE.

The never-fabricate invariant

The single rule the whole library is built around: the engine never invents a code, display, unit, or map target.

• A $translate over an unmapped source returns a typed unmapped result - surfaced, carrying any declared group.unmapped fallback mode - never a guessed target.
• Every target translate returns is drawn verbatim from the supplied map.
• An unrecognized code system resolves to a typed unknown, never a guessed URI.
• A ValueSet $expand whose parts cannot all be computed (a missing code system, an unimplemented filter, a truncated server expansion) returns complete: false with a typed TERM_VALUESET_CANNOT_EXPAND / TERM_VALUESET_EXPANSION_TRUNCATED diagnostic - the contains set is a lower bound, never a silently-empty membership.
• ValueSet binding (validateCodeInValueSet) returns a decided result only when it can prove membership; otherwise a typed undetermined - never a fabricated "not a member", because a false negative on a binding is a clinical error.

The never-invert invariant

Real steward maps (SNOMED→ICD-10-CM, the GEMs) are approximate, 1:many, and non-invertible. translate reads a map in its authored direction only - it matches a source coding against the map's source-side codes and never against targets - so a directional map cannot be run backwards. Reverse translation requires an explicit inverse map; it is never synthesized. The CMS GEMs make this explicit: the forward (9→10) and backward (10→9) files are separate artifacts, and invertGem throws TERM_MAP_NOT_INVERTIBLE rather than fabricate a transpose.

The crosswalk resolvers

The published reference maps are the library's highest-risk surface, and the stewards say so in as many words - CMS: "GEMs are not crosswalks. They are reference mappings"; NLM: the SNOMED→ICD-10-CM map is "semi-automated." The resolvers honour that.

• ICD-9↔ICD-10 GEMs (loadGems / applyGem) - CMS public-domain. Each entry carries the steward's 5-position flags (approximate | no-map | combination | scenario | choice-list), surfaced verbatim. A 1:many source returns the whole candidate set; a combination source surfaces its scenario→choice-list structure so a caller can build valid clusters (one target per choice list); a NoDx No-Map source is the typed TERM_CROSSWALK_NO_MAP, distinct from a source simply absent from the file (TERM_CROSSWALK_UNMAPPED).
• SNOMED CT → ICD-10-CM complex map (loadComplexMap / applyComplexMap) - BYO (SNOMED is licensed; the engine bundles no SNOMED CT refset or release - it bundles the rule machinery and the individual concepts that machinery names, the map categories and the two gender findings). A source's map groups are an AND (a manifestation code and an etiology code → two groups); within a group, priorities are an if-then-else chain of IFA rules evaluated against caller-supplied PatientContext (age band, gender). A group whose decision needs context the caller did not supply is the typed TERM_CROSSWALK_CONTEXT_REQUIRED - the candidate rules and Map Advice ride through, and the engine refuses to pick a branch it lacks the data for. Steward Map Categories (447638001 cannot-classify, 447639009 context-dependent, 447640006 ambiguous) are carried verbatim.

Both are directional and never inverted, and both extend the same never-fabricate rule: a crosswalk never invents a target, and "No-Map" is a first-class typed outcome, never an empty success.

The RxNorm drug graph

RxNorm's drug graph - ingredient (IN) → clinical-drug component (SCDC) → semantic clinical drug (SCD) → semantic branded drug (SBD), with brand (BN) and dose-form (DF) cross-links - is navigated over a bring-your-own RxNorm RRF release (loadRxNormGraph reads RXNCONSO concepts, RXNREL relationships, and RXNSAT NDC attributes). The engine bundles no RxNorm release; the graph is entirely the caller's release, and a resolution is release-scoped.

• Direction is a documented trap, grounded firsthand. RxNorm's RXNREL stores each relationship as "the relationship which the second concept (RXCUI2) HAS TO the first (RXCUI1)" (NLM RxNorm Technical Documentation §12.7; UMLS Reference Manual). So a row is read RXCUI2 ⟶RELA⟶ RXCUI1, and the loader normalizes every edge to subject = RXCUI2, object = RXCUI1. A has_ingredient row therefore puts the concept that has the ingredient in RXCUI2 and what it has in RXCUI1. Getting this backwards is a wrong-medication bug, so it is pinned by fixtures.
• Direction is not topology. Knowing how to read a row does not tell you which rows exist, and RxNorm's ingredient topology is not the obvious one. has_ingredient is authored from the clinical side (SCDC/SCDF/SCDG) to the ingredient IN, and from the branded side (SBD/SBDC/SBDF/SBDG) to the brand name BN rather than to the active ingredient. There is no SCD ⟶ IN edge in any release, so ingredientsOf on a clinical drug answers with an honest empty set, and an active ingredient is reached by walking to the clinical component and taking its edge (SCD ⟶ SCDC ⟶ IN; from an SBD, consists_of returns the SBDC as well as the SCDC, and it is the SCDC that leads to the IN). Likewise IN ingredient_of reaches components and dose forms, never the clinical drug. The precise forms (SCDFP/SBDFP/SCDGP) carry no ingredient edge either: an SCDFP reaches its basis-of-strength substance(s) by has_boss, a one-to-many relation whose targets can be a PIN or a plain IN and which ingredientsOf does not follow, and the other two author none at all. Read the tty of what a traversal returns rather than assuming it from the one you queried.
• A concept is typed by its defining atom, never by file position. An RXCUI carries one defining atom (its normalized name: IN, SCD, SCDF, BN, and so on) plus any number of synonym atoms, whose TTY (PSN, SY, TMSY) the NLM defines as a "synonym of another TTY": it types a name, not a concept. RxNorm documents no ordering between an RXCUI's atoms, so the loader takes the defining one wherever it sits and never falls back to a synonym. An RXCUI that no defining atom could type is left out of the graph and surfaced as TERM_RXNORM_UNTYPED_CONCEPT. Refusing is the safer direction: an absent concept is already a first-class typed answer (TERM_RXNORM_UNKNOWN_RXCUI), while a concept whose tty reads TMSY is a fabricated claim about what the drug is, and a caller cannot tell it from a real one.
• Authored edges only - never inverted. RxNorm ships both directions of an asymmetric relationship as separate rows, so genericFor follows the authored tradename_of and brandsFor follows the authored has_tradename; the engine never synthesizes a reverse edge. Convenience resolvers (ingredientsOf, doseFormsOf, consistsOf) and the generic relatedByRela all follow authored predicates.
• Never fabricate. A queried RXCUI absent from the release is a typed TERM_RXNORM_UNKNOWN_RXCUI; a present concept with no such relationship is a found result with an empty target set (an honest "no such edge", distinct from "unknown concept"). An NDC not in the release is a typed TERM_RXNORM_NDC_UNMAPPED, never a guessed RXCUI.
• NDC↔RXCUI is many:1 and temporal. resolveNdc carries the temporal status (active/obsolete/alien/unknown) and the as-of release - an NDC present in the loaded release is active as of that release; obsolete/alien statuses come from RxNav NDC-history data (a differential/BYO source, not the base RRF concept files) and are never fabricated.
• Coverage is not correctness. Approximate name matching (approximateMatch) is an opt-in, explicitly labeled path - never the default resolution and never an exact assertion (every candidate carries approximate: true and a derived score). A "no match" is an empty array, never a nearest guess.

Content posture. This release ships the graph mechanism over the real RRF format, grounded firsthand on the RxNorm technical documentation; it bundles RxNorm's relationship and term-type names but no RxNorm release. The public-domain Current Prescribable Content pack is not bundled either: bundling one requires a genuine, verbatim RxNorm release, and none is fabricated to fill the gap.

Liberal load, conservative assertion

Loading is liberal: loadConceptMap accepts an untrusted unknown and degrades a malformed resource to a typed fatal (TERM_CONCEPTMAP_MALFORMED) rather than crashing - but it refuses to load a structurally partial, misleading map. Assertion is conservative: a 1:many mapping returns the full candidate set (never collapsed to one), and steward advice comments ride through verbatim.

Stable diagnostic + fatal codes

Outcomes carry stable codes - DIAGNOSTIC_CODES (typed, surfaced, non-throwing outcomes like TERM_TRANSLATE_UNMAPPED) and FATAL_CODES (thrown, like TERM_CONCEPTMAP_MALFORMED). Consumers branch on these, so a code's name is part of the public contract: renaming or removing one is a breaking change. Diagnostics are value-free - a code plus, at most, a code + system + version, never a surrounding patient identifier (a code in patient context can be PHI).

Immutability

Every value the engine returns - a loaded ConceptMap, a Coding, a TranslateResult - is deep-frozen, so it is safe to share across a pipeline without defensive copying.