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.