External partners, including standards subject matter experts, government agencies, interoperability specification developers, and healthcare data providers and consumers nationwide, will benefit from improved semantic healthcare interoperability, simplified adoption of clinical terminologies and other Code Systems, as well as timely access to national and international standards. Infoway is proud of the partnership with Dedalus and our ongoing role as a convener of essential healthcare partners, as these partnerships help drive the advancement of interoperable digital health solutions and foster a connected healthcare system.

The partnership with Dedalus to develop the Terminology Server signifies a pivotal moment in the sustainable advancement of digital health solutions in Canada by fostering improved system and semantic interoperability, simplifying the adoption of clinical terminologies, and ultimately, enhancing the quality of care for all Canadians.

The new Terminology Server will primarily utilize a FHIR API for accessing and managing terminologies. The Terminology Gateway will still be available till the end of 2024. As we transition fully to the new terminology server, users are encouraged to start using the new Terminology Server to become familiar with the features and benefits of a FHIR terminology server.

The exact date for the full decommissioning of the Terminology Gateway is yet to be determined, but it is intended to be decommissioned in December 2024. Until then, both Terminology Gateway and the new Terminology Server will serve as sources of truth, with all content maintained in both systems to ensure continuity and accuracy. During the public beta launch, users are encouraged to explore and familiarize themselves with the new Terminology Server while continuing to use the Terminology Gateway for ongoing needs. Please note that content migration will be staggered, and some terminology artifacts such as CCDD and PrescribeIT, may not be available in the initial beta launch. We will keep users updated as the plan progresses, guided by expert recommendations and user adoption metrics.

Yes, Ontoserver enables users to browse, search, and download content in FHIR formats, specifically XML and JSON. For certain operations, such as Value Set $expand, it also provides simplified, flattened representations (e.g., CSV). Additionally, RF2 files will be available from the Syndication Server API. For some terminology content, additional formats (such as Excel) will be made available through the Syndication API to support transition needs.

No, these terms are often used interchangeably. A subset is a mathematical as a set of elements that are all contained within another set, which in this context means a specific selection of codes from a larger set. It is also a curated collection of codes from a larger terminology, tailored for specific clinical or administrative contexts. It ensures relevance and consistency by providing a focused list of codes pertinent to particular scenarios.

A Value Set is a collection of codes derived from one or more Code Systems, defined by specific criteria or an explicit list. Used in standards like HL7 FHIR, it supports interoperability by specifying permissible codes for data elements, such as acceptable values for a "diagnosis" field in electronic health records.

As part of the transition to a FHIR-based Terminology Server, there will be no changes to how Value Sets are accessed for review purposes. The Canonical Value Set FHIR URIs in IGs should already be using the Value Set FHIR URI and these will be mapped to the new FHIR-based Terminology Server.

Yes, the Terminology Server is designed to support all FHIR terminology operations including the Value Sets compose element (both intensional and extensional) to perform the $validate-code operation. The current approach is to load all Value Sets onto the Terminology Server as composed rather than pre-expanded. This enables enhanced functionality, including $validate-code, and allows for $expand operations. The $expand operation supports full expansion requests and a wide variety of parameterized and focused expansions. For more information, please refer to the HL7 FHIR documentation.

Value Sets Requests for Change (RFC) process for SNOMED CT, LOINC, PrescribeIT, and CCDD will be changing in a phased approach. However, as of July 15th, the HL7 Value Sets will automatically be updated in the Terminology Server via releases from HL7 Terminology (THO).

• Phase 1 (July to December 2024): During this period, the InfoRMS request for change process remains status quo.
• Phase 2 (January 2025 onwards): Beginning January 2025, permissions for authorized users will be granted for Snapper Authoring. This will allow users to create new and update existing Value Sets in the staging environment pending approval by the Canadian Release Standards Centre for loading into the Production environment. In addition, Terminology Gateway will no longer be updated with any new changes to Value Sets.

Over the next few months, authoring for Value Sets in Snapper will be introduced to users through role-based access control (RBAC). Users will be granted permission to author where deemed appropriate by Infoway. This will allow users to create new and update existing Value Sets pending review, validation and approval by the Canadian Release Standards Centre before promotion to a production release. Currently, a Snapper user guide and video tutorial are available to help learn authoring in the tool. More details to come in the coming months.

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While Ontoserver has the capability for runtime use and access by end systems, Infoway’s Terminology Server currently does not cover runtime use by end systems within its Service Level Agreement (SLA). However, there is an opportunity to increase the SLA based on expected use and interaction levels. Alternatively, the content available in the Terminology Server can be syndicated for runtime use, allowing consumer systems to have autonomous control over the terminology data.

Ontoserver is designed to support both small-scale use and large-scale deployments, capable of evolving with Infoway’s changing requirements. The common use case is as a read-only server that provides runtime access to released terminology content. This ensures that it can service a wide range of deployment sizes and needs, offering flexibility and scalability.

Ontoserver is designed to be flexible and can function both as an integrated component and as a standalone solution.

Systems can integrate with the Terminology Server in various ways. For example, some systems may use it to subscribe to and download the latest terminology content, which they then load into their internal systems to create their own representation of the information.

Additionally, Ontoserver can support vendor-specific functions, allowing systems to find specific representations of terminology as needed.

With its FHIR APIs, Ontoserver enables richer integration with the terminology service, allowing for runtime use and unlocking advanced capabilities that may be challenging to achieve otherwise.

The goal of the Terminology Server is to drive improvements in consistent data representation and facilitate the collection of standardized data, benefiting both large systems and smaller vendors. By externalizing terminology through APIs, Ontoserver ensures consistent access to terminology across various platforms.

Shrimp is designed as a terminology browser and visual explorer, allowing users to search and view terminology content. While downloading subsets directly from Shrimp isn’t part of its core functionality, we understand the need for this feature and are exploring alternative ways to meet it. For now, we recommend using Snapper to download resources. Detailed instructions on how to navigate Snapper can be found in our training resources section in the user guide and video.

Shrimp has been enhanced with a language toggle in the top right-hand corner, which applies to both the terminology content and the application interface, including menus and links. To browse in your preferred language, you can use the language toggle to select “en” or “fr”. Please note that as the Shrimp browser is available globally, there may be additional languages added in the menu options. For example, “id” which represents the Indonesian language. This would not apply to Canadian terminology content which is available only in EN and FR. Please see our Shrimp User Guide for more details regarding this new feature. We appreciate your continued patience as we work to further improve this functionality.

Yes, you can use the following API calls to determine the latest version for code systems, such as SNOMED CT and pCLOCD within the Postman Collection. For detailed instructions on how to access the Postman Collection, please refer to the following link: System-to-System Account Requisition Process:

• For SNOMED CT, please use the following:
  • HTTP GET
    https://terminologystandardsservice.ca/fhir/CodeSystem?url=http://snomed.info/sct&_elements=version&_sort=-version&_count=1
• For pCLOCD, please use the following:
  • HTTP GET
    https://terminologystandardsservice.ca/fhir/ValueSet/$expand?url=https://fhir.infoway-inforoute.ca/CodeSystem/pCLOCD?fhir_vs&count=0

Please note that you will need to authenticate before making these requests.

Example CURL Command is provided below:

We greatly value your feedback and are constantly looking for ways to improve the user experience. Some of the requested enhancements are outside the immediate scope of the current project and may require customization of tools that aren’t directly managed by Infoway or our partners. However, we are working closely with stakeholders to explore possible solutions. Although we can’t commit to specific timelines right now, please know that we are dedicated to improving the overall experience, and your input plays a vital role in shaping these improvements. We truly appreciate your understanding and patience as we continue to work on this.

Yes, “latest” refers to the most recent version of the Code System available in the current versioning stream. We aim to ensure that the most up-to-date content is accessible in the Terminology Server. For guidance on browsing Code Systems in Shrimp, the Shrimp User Guide and Shrimp training video are available in the training resources section for your reference.

Yes, there are two ways to access this content. One method involves using an API, such as Postman, which can handle larger datasets without the limitations that may be encountered with other tools. A demonstration of this process is available in our training video, "Terminology Server Drop-in Session FHIR API" (timestamp 35:20). If you need access to the entire content, the Syndication server allows you to retrieve the full artifact.

Depending on your needs, it’s important to choose the correct format for downloading the content. We always make the FHIR representation available, with the exception of SNOMED CT CA and LOINC. For these two Code Systems, there are binary and native versions, as they cannot be represented in a flat Code System. For simpler, standard artifacts, the Syndication system provides all the necessary data.

All pan-Canadian Value Sets defined by Infoway will transition to semantic versioning as part of the migration to the new Terminology Server.

• Semantic versioning is considered a best practice, especially as we move to a fully FHIR-enabled Terminology Server. It reduces conflicts and maintenance efforts for FHIR Implementation Guide (IG) developers and implementers by providing a more consistent versioning structure. The shift addresses known limitations of dynamic versioning in the Terminology Gateway, a concern discussed and supported by the expert community. More information on these discussions can be found here: FHIR Chat Discussion on Versioning.

Changes for Implementers:

• Baseline Versioning: All Value Sets on the new Terminology Server will begin with a baseline version of 1.0.0, following semantic versioning principles for improved stability and predictability in updates.
• Continuity with Terminology Gateway: The versioning on the current Terminology Gateway will remain unchanged for the foreseeable future, allowing users still using the Gateway to maintain continuity during the transition.
• Consistency and Clarity: Semantic versioning clearly communicates the significance of changes. Major updates (e.g., 2.0.0) indicate breaking changes, while minor or patch updates (e.g., 1.1.0 or 1.0.1) signify additions or fixes without disruption, aiding implementers in assessing impacts.
• Simplified Upgrades and Compatibility: Implementers gain better visibility into backward-compatible changes, streamlining the update process by clarifying when major upgrades are necessary versus when minor updates can be safely applied.
• Improved Governance and Change Management: The new versioning scheme allows implementers to align their processes for managing updates, establishing protocols to adopt changes while minimizing disruption risks.
• Impact on Implementation Timelines: Unlike date-based versioning, updates under semantic versioning will depend on the nature of changes rather than a fixed schedule, potentially altering when updates need to be applied by implementers.

This transition aims to streamline the management of Value Sets, enhance stability, and simplify the implementation process for developers and users alike.

From the FHIR perspective, the national SNOMED CT CA Edition code.system is the default global code system "http://snomed.info/sct". Use of “version’ would be included to denote that a code is from the Canadian Edition. This version is based on the most dependent module (French module): http://snomed.info/sct/20611000087101.

If an implementation is not leveraging a Canadian terminology service such as Infoway’s Terminology Server that defaults to the Canadian Edition, solutions would need to include the SNOMED CT CA Edition (in the coding.version)

Examples by Use Case

1. Example of recommended format without reference to version for use in Canada in ecosystems where tooling and vendor software implicitly use the SNOMED CT CA edition in their valuesets, terminology services (e.g. National Vaccine Catalogue):

   

2. Example of recommended format including version for use in ecosystems where data exchange may occur with tooling and vendor software that operate in US or other jurisdictions where SNOMED CT CA edition isn’t the default. This might apply to vendors that use SNOMED International or SNOMED CT US Edition by default, for example, such as a US based vendor operating in Canada (e.g.  for smartphone apps).

Guidance on the application of code system versioning

For implementers, look to the respective FHIR Implementation Guide for guidance on whether to include the code system version.

For FHIR implementation guide authors, use the guidance above based on the expected data exchange ecosystem.