diff --git a/npm-shrinkwrap.json b/npm-shrinkwrap.json
index 323d2a15c..e30d0b1b1 100644
--- a/npm-shrinkwrap.json
+++ b/npm-shrinkwrap.json
@@ -848,9 +848,9 @@
       }
     },
     "node_modules/@eslint/plugin-kit": {
-      "version": "0.2.2",
-      "resolved": "https://registry.npmjs.org/@eslint/plugin-kit/-/plugin-kit-0.2.2.tgz",
-      "integrity": "sha512-CXtq5nR4Su+2I47WPOlWud98Y5Lv8Kyxp2ukhgFx/eW6Blm18VXJO5WuQylPugRo8nbluoi6GvvxBLqHcvqUUw==",
+      "version": "0.2.3",
+      "resolved": "https://registry.npmjs.org/@eslint/plugin-kit/-/plugin-kit-0.2.3.tgz",
+      "integrity": "sha512-2b/g5hRmpbb1o4GnTZax9N9m0FXzz9OV42ZzI4rDDMDuHUqigAiQCEWChBWCY4ztAGVRjoWT19v0yMmc5/L5kA==",
       "dev": true,
       "license": "Apache-2.0",
       "dependencies": {
@@ -2648,10 +2648,11 @@
       "dev": true
     },
     "node_modules/cross-spawn": {
-      "version": "7.0.3",
-      "resolved": "https://registry.npmjs.org/cross-spawn/-/cross-spawn-7.0.3.tgz",
-      "integrity": "sha512-iRDPJKUPVEND7dHPO8rkbOnPpyDygcDFtWjpeWNCgy8WP2rXcxXL8TskReQl6OrB2G7+UJrags1q15Fudc7G6w==",
+      "version": "7.0.6",
+      "resolved": "https://registry.npmjs.org/cross-spawn/-/cross-spawn-7.0.6.tgz",
+      "integrity": "sha512-uV2QOWP2nWzsy2aMp8aRibhi9dlzF5Hgh5SHaB9OiTGEyDTiJJyx0uy51QXdyWbtAHNua4XJzUKca3OzKUd3vA==",
       "dev": true,
+      "license": "MIT",
       "dependencies": {
         "path-key": "^3.1.0",
         "shebang-command": "^2.0.0",
diff --git a/src/fhirtypes/ElementDefinition.ts b/src/fhirtypes/ElementDefinition.ts
index e81601a55..3764f6deb 100644
--- a/src/fhirtypes/ElementDefinition.ts
+++ b/src/fhirtypes/ElementDefinition.ts
@@ -386,13 +386,27 @@ export class ElementDefinition {
     validationErrors.push(
       this.validateIncludes(slicing.rules, ALLOWED_SLICING_RULES, 'slicing.rules')
     );
-
+    const isR4 = this.structDef.fhirVersion.startsWith('4.');
     slicing.discriminator?.forEach((d, i) => {
       const discriminatorPath = `slicing.discriminator[${i}]`;
       validationErrors.push(this.validateRequired(d.type, `${discriminatorPath}.type`));
-      validationErrors.push(
-        this.validateIncludes(d.type, ALLOWED_DISCRIMINATOR_TYPES, `${discriminatorPath}.type`)
-      );
+      if (isR4) {
+        validationErrors.push(
+          this.validateIncludes(d.type, ALLOWED_DISCRIMINATOR_TYPES, `${discriminatorPath}.type`)
+        );
+      } else {
+        validationErrors.push(
+          this.validateIncludes(d.type, ALLOWED_DISCRIMINATOR_TYPES_R5, `${discriminatorPath}.type`)
+        );
+        if (d.type === 'position' && slicing.ordered !== true) {
+          validationErrors.push(
+            new ValidationError(
+              'Slicing ordering must be true when a position discriminator is used.',
+              'slicing.ordered'
+            )
+          );
+        }
+      }
       validationErrors.push(this.validateRequired(d.path, `${discriminatorPath}.path`));
     });
     return validationErrors.filter(e => e);
@@ -3076,6 +3090,15 @@ export type ElementDefinitionSlicingDiscriminator = {
 // Cannot constrain ElementDefinitionSlicingDiscriminator to have these values as a type
 // since we want to process other string values, but log an error
 const ALLOWED_DISCRIMINATOR_TYPES = ['value', 'exists', 'pattern', 'type', 'profile'];
+// R5 introduced the 'position' discriminator
+const ALLOWED_DISCRIMINATOR_TYPES_R5 = [
+  'value',
+  'exists',
+  'pattern',
+  'type',
+  'profile',
+  'position'
+];
 
 export type ElementDefinitionBase = {
   path: string;
diff --git a/test/fhirtypes/ElementDefinition.test.ts b/test/fhirtypes/ElementDefinition.test.ts
index 556fd0a5c..9fbcb38d1 100644
--- a/test/fhirtypes/ElementDefinition.test.ts
+++ b/test/fhirtypes/ElementDefinition.test.ts
@@ -1112,5 +1112,69 @@ describe('ElementDefinition', () => {
         /slicing.discriminator\[0\].type: Invalid value: #foo. Value must be selected from one of the following: #value, #exists, #pattern, #type, #profile/
       );
     });
+
+    it('should be invalid when an element has a position discriminator, ordered is true, and the FHIR version is older than R5', () => {
+      const clone = valueX.clone(false);
+      clone.slicing = {
+        rules: 'open',
+        ordered: true,
+        discriminator: [{ path: '$this', type: 'position' }]
+      };
+      const validationErrors = clone.validate();
+      expect(validationErrors).toHaveLength(1);
+      expect(validationErrors[0].message).toMatch(
+        /slicing.discriminator\[0\].type: Invalid value: #position. Value must be selected from one of the following: #value, #exists, #pattern, #type, #profile/
+      );
+    });
+  });
+});
+
+describe('ElementDefinition R5', () => {
+  let defs: FHIRDefinitions;
+  let jsonObservation: any;
+  let jsonValueX: any;
+  let observation: StructureDefinition;
+  let valueX: ElementDefinition;
+  let fisher: TestFisher;
+
+  beforeAll(() => {
+    defs = new FHIRDefinitions();
+    loadFromPath(path.join(__dirname, '..', 'testhelpers', 'testdefs'), 'r5-definitions', defs);
+    fisher = new TestFisher().withFHIR(defs);
+    // resolve observation once to ensure it is present in defs
+    observation = fisher.fishForStructureDefinition('Observation');
+    jsonObservation = defs.fishForFHIR('Observation', Type.Resource);
+    jsonValueX = jsonObservation.snapshot.element[21];
+  });
+
+  beforeEach(() => {
+    observation = StructureDefinition.fromJSON(jsonObservation);
+    valueX = ElementDefinition.fromJSON(jsonValueX);
+    valueX.structDef = observation;
+  });
+
+  it('should be valid when an element has a position discriminator, ordered is true, and the FHIR version is R5 is newer', () => {
+    const clone = valueX.clone(false);
+    clone.slicing = {
+      rules: 'open',
+      ordered: true,
+      discriminator: [{ path: '$this', type: 'position' }]
+    };
+    const validationErrors = clone.validate();
+    expect(validationErrors).toHaveLength(0);
+  });
+
+  it('should be invalid when an element has a position discriminator, ordered is not true, and the FHIR version is R5 or newer', () => {
+    const clone = valueX.clone(false);
+    clone.structDef.fhirVersion = '5.0.0';
+    clone.slicing = {
+      rules: 'open',
+      discriminator: [{ path: '$this', type: 'position' }]
+    };
+    const validationErrors = clone.validate();
+    expect(validationErrors).toHaveLength(1);
+    expect(validationErrors[0].message).toMatch(
+      /slicing\.ordered: Slicing ordering must be true when a position discriminator is used/
+    );
   });
 });