Introduction
Canada Health Infoway is excited to introduce our innovative Terminology Server, a managed service solution that serves as a helpful resource for standards subject matter experts, developers, healthcare organizations, vendors, healthcare data providers, and consumers nationwide.
Our Terminology Server is powered by Ontoserver from CSIRO. The Ontoserver product is a world-leading clinical terminology solution implementing FHIR terminology services and supporting syndication–based content. This advanced technology ensures that our Terminology Server is equipped to meet the highest levels of healthcare interoperability and improved healthcare delivery across Canada.
What is a Terminology Server?
Infoway’s Terminology Server is a fully HL7 FHIR-compliant, cloud-based solution that stores, maintains, and distributes international and nationally approved terminologies. It offers scalability, security, reliability, and flexibility for secure access. The server hosts high-quality international and pan-Canadian terminologies, as well as Value Sets, making these resources accessible and shareable across digital health solutions, systems, and healthcare data providers to facilitate standardization of health data. This fosters interoperability and semantic consistency.
What are the Terminology Server Benefits?
Centralizes Access to Standardized Health Terminologies. Serves as a central repository for those maintaining standardized healthcare terminologies and those using the content, ensuring uniformity in data collection and data exchange.
Enables Interoperability. Facilitates more frequent updates of standard clinical terminologies across diverse pan-Canadian digital solutions and systems. This enables health care staff to access more reliable, standardized information, leading to more informed treatment decisions and improved patient care.
Supports Improved Collaboration. Tools to enable content creation and content use, offering the ability to participate as part of the healthcare ecosystem and work collaboratively.
Provides Pathways for Advanced Use of Terminologies. Realizes the benefits of adopting terminologies for enhanced reporting, analytics, and research purposes through the availability of comparable information.
Fully Enabled FHIR Terminology Capabilities. Includes broad support for the standard FHIR terminology resources and operations. These capabilities include Search, Create, Read, Update, and Delete operations on ValueSet, ConceptMap, CodeSystem, NamingSystem, and StructureDefinition; as well as other terminology-specific operations such as $expand, $validate-code, $lookup, $subsumes, $find-matches, $closure, $translate, and $validate.
Information Modeling and Specification Development. Support Concept Maps, binds terminology and Value Sets to data models and specifications, validates terminology content against specifications, and ensures FHIR resource compliance.
Smart Data Entry and Performant Run Time Use. Supports efficient smart search of SNOMED CT and other Code Systems in clinical information systems and enables advanced use of SNOMED CT for decision support and subsumption.
Terminology Server Content
The Terminology Server provides access to Code Systems, Value Sets, and other Terminology artifacts for International and Canadian Terminologies, and Classifications, such as:
- SNOMED CT CA
- LOINC, pCLOCD
- UCUM
- Pan-Canadian Value Sets
- Canadian Clinical Drug Data Set (CCDD)
Who Can Use the Terminology Server?
The Terminology Server is designed for:
- Jurisdictions
- Developers
- Vendors
- Healthcare Organizations & Healthcare Data Providers
- Health Terminology Standards Specialists
- Health Researchers
Accessing the Terminology Server
Individual users can access the Terminology Server with a registered InfoCentral account. To assist with this, a comprehensive User Access Guide is available, providing detailed instructions on accessing and utilizing the Terminology Server.
The Terminology Server implements robust security measures, including role-based access control, encryption, and audit logging, to ensure that sensitive terminology data is protected and accessed only by authorized users. Infoway remains committed to prioritizing security and privacy in all its endeavors, including in our partnerships and when deploying new tools and solutions.
The Terminology Server also offers RESTful HTTP APIs, supporting both JSON and XML formats. This allows any platform, application, or integration engine capable of making RESTful HTTP calls and processing JSON or XML to interact with the Terminology Server. The FHIR APIs enable rich integration with the Terminology Server, facilitating both the subscription to and download of the latest content, as well as enabling runtime use of the terminology. This unlocks the full potential of the terminology, driving improvements in consistent data representation and the ability to collect standardized data.
The Terminology Server supports various integration approaches, allowing systems to incorporate the latest terminology content and create internal system representations. It also facilitates vendor-specific functions to find system-specific representations of the terminology if needed. By externalizing terminology through APIs, the Terminology Server ensures consistency in how terminology is accessed across different systems and vendors. This approach benefits both large systems and smaller vendors, promoting standardized data usage and interoperability.
System Access
Developers and system administrators can choose to communicate to the new terminology server using an automated script or software application. A system account is required for making API calls to Infoway’s Terminology Server. The system account requisition process provides the steps for this access. This process involves submitting a request form in order to receive system credentials specific to your project or organization. These credentials will be exchanged for an authorization token which will allow your system to communicate with the Terminology Server without any personal username and password. The credentials should be kept safe and private, similar to any username and password.
Some examples of where these system API calls would be required are:
- Querying the Terminology Server FHIR API to access CodeSystems, ValueSets and more
- Downloading files from the Terminology Server Syndication server
HL7 Tools Integration
The new terminology server integrates easily with the HL7 International FHIR tooling ecosystem, including the Implementation Guide (IG) Publisher and FHIR Validator, offering several key benefits:
- Direct access for users to Infoway-hosted code systems and value sets within Implementation Guides (IGs) without the need for duplicating content or using “stub” ValueSets.
- Access to Infoway-hosted code systems and value sets in the HL7 FHIR Validator, eliminating the need to manage content separately for validation.
- Canadian terminologies like SNOMED CT CA are automatically updated in the HL7 ecosystem, ensuring users always have access to the latest standards without delays or manual updates.
- Validation processes at events like the IHE Connectathon and Projectathons are streamlined, allowing users to validate directly against Infoway-hosted terminologies, saving time and simplifying conformance testing.
How to Get Started
To begin, you will need a user-specific API key from Infoway, making it easy to configure HL7 tools for seamless terminology access. For more detailed instructions you can refer to Infoway’s System Account Requisition process and HL7’s documentation .
Supported Versions
- HL7 IG Publisher version 1.8.1 or later
- HL7 Validator version 6.5.0 or later
Terminology Server Tools:
The Terminology Server offers several tools to consume and understand the FHIR Resources available via Infoway’s Terminology Server.
Shrimp Browser:
- Browse and explore Code Systems and hierarchies
- Browse and explore Value Sets
- Build and evaluate SNOMED CT ECL expressions
- Download SNOMED CT ECL Expansions
OntoCommand:
- Understand what FHIR resources are available on server
- View resource metadata
- Perform comparisons of FHIR resources
Snapper:
- Understand the construction of a FHIR resource
- Download a FHIR resource
Tool |
Description |
Direct Link |
Documentation |
Terminology Dashboard (OntoCommand) |
OntoCommand provides a dashboard interface for interacting with a FHIR® Terminology Server. | https://ontoserver.csiro.au/ui/launch?iss=https://terminologystandardsservice.ca/fhir | OntoCommand |
Terminology Browser (Shrimp) | Shrimp is an online terminology browser for any FHIR CodeSystem, particularly hierarchical, and optimised for SNOMED CT and LOINC | https://ontoserver.csiro.au/shrimp/launch.html?iss=https://terminologystandardsservice.ca/fhir | Shrimp |
Terminology Authoring (Snapper) |
The Authoring Tool is comprised of Snapper:Author and Snapper:Map components. To access both components follow the links below. Snapper: Author enables the creation and maintenance of the FHIR® terminology resources: CodeSystem, ValueSet, and ConceptMap. Snapper: Map streamlines ConceptMap authoring and maintenance |
https://ontoserver.csiro.au/snapper/?iss=https://terminologystandardsservice.ca/fhir | Snapper |
Authorization URL | https://terminologystandardsservice.ca/authorisation/auth/realms/terminology/protocol/openid-connect/auth |
Access Token | https://terminologystandardsservice.ca/authorisation/auth/realms/terminology/protocol/openid-connect/token |
Production FHIR | https://terminologystandardsservice.ca/fhir |
Production Admin | https://terminologystandardsservice.ca/api |
Production Syndication | https://terminologystandardsservice.ca/synd |
Authoring FHIR | https://terminologystandardsservice.ca/authoring/fhir |
Authoring Admin | https://terminologystandardsservice.ca/authoring/api |
Authoring Syndication | https://terminologystandardsservice.ca/authoring/synd |
Training Resources
We recognize that users have varying levels of knowledge and understanding about our Terminology Server (Ontoserver). These online training resources are designed to aid in understanding and leveraging the full capabilities of the solution.
Terminology Server Overview:
- Ontoserver Overview Video (28 mins)
- FHIR Terminology Services Operations (45 mins)
- FHIR Terminology Resources (36 mins)
- CSIRO Workshop: Ontoserver Overview with Q&A (157 mins)
Training Videos & User Guides:
Terminology Server:
Shrimp:
- How to Use the Terminology Service: Introduction to Shrimp (66 mins)
- CCDD Terminology Server Demo Introductory Walkthrough (48 mins)
- Shrimp User Guide
Snapper & OntoCommand
- How to Use the Terminology Service: Read Only Use Case Walkthrough (25 mins)
- How to Use the Terminology Service: Basic Content Authoring Using Snapper (58 mins)
- OntoCommand User Guide
- Snapper User Guide
FHIR API
Frequently Asked Questions
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 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
- HTTP GET
- 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
- HTTP GET
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
- 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):
- 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.
Contact us for Support
Your feedback is invaluable in helping us refine and improve our Terminology Server and we look forward to your continued support and collaboration to ensure that together we are driving health care interoperability forward in Canada. Please use the above contact us method to submit your feedback.
Disclaimer: Infoway’s Terminology Server shares Provider Content and User Content to support healthcare terminology data usage. While we strive to ensure the quality, accuracy, and completeness of the content provided, it is ultimately the User’s responsible to ensure that the content is adequate for the intended use. Infoway disclaims any liability for errors and/or omissions in said content, which is provided “as is” in accordance with our Terms of Use.
Terminology licensing information