What is the NHS Terminology Server?
In healthcare, different systems often use varied terminologies to describe the same conditions or treatments. For instance, one system might record a diagnosis as “chest infection,” while another uses “upper respiratory infection.” These discrepancies complicate data sharing and analysis. The NHS Terminology Server resolves this by serving as a central repository for assured terminologies like SNOMED CT, ICD-10, and the dictionary of medicines and devices (dm+d). By offering accurate, standardised data, the server enables healthcare systems to “speak the same language,” fostering better decision-making, enhanced analytics, and efficient service delivery.
The Terminology Server supports advanced functionalities, including the mapping of local codes to national or international standards and distributing updates via APIs, eliminating the need for manual content updates. This standardisation improves not only data consistency but also interoperability across electronic health records (EHRs), analytics platforms, and other healthcare IT solutions.
Core Features of the NHS Terminology Server
The Terminology Server is built to meet the needs of diverse stakeholders, from healthcare providers to researchers and software vendors. Its key features include:
- Support for Multiple Standards: The server hosts assured terminologies such as SNOMED CT, ICD-10, dm+d, Human Phenotype Ontology (HPO), and READ codes. It also includes historical versions for continuity.
- FHIR Compliance: By adhering to the FHIR standard, the server ensures that data is accessible through APIs in formats that are widely supported in the healthcare IT community.
- Authoring and Maintenance: Tools like Snapper:Author enable users to create and manage local content, value sets, and mappings, ensuring that national and organisational requirements are met.
- Syndication: The server provides a syndication feed via an Atom API, allowing organisations to receive updates and distribute their content to other systems.
- Performance Optimisation: Features like smart data entry and performant search functionalities facilitate efficient querying and runtime use, enabling real-time decision support and analytics.
How Digital Health Innovators Can Integrate
Integrating with the NHS Terminology Server offers numerous benefits for digital health innovators, including enhanced interoperability, reduced development effort, and improved compliance with NHS standards. Below are steps and strategies to effectively integrate with the server:
1. Understand FHIR and the Terminology Server Ecosystem
The Terminology Server is deeply rooted in FHIR R4, a globally recognised standard for healthcare data exchange. Innovators should familiarise themselves with core FHIR resources such as CodeSystem, ValueSet, and ConceptMap. These are central to defining, binding, and mapping terminologies within the server.
NHS England provides comprehensive documentation, including a GitHub repository with examples and code snippets to simplify onboarding. Innovators can access guidance on topics ranging from basic API usage to advanced analytics and decision support – https://digital.nhs.uk/services/terminology-server.
2. Access the Server
Accessing the NHS Terminology Server requires an account. Individual users can register for authenticated access, while system-to-system integration requires a dedicated account for API usage. Once access is granted, innovators can interact with the server’s various environments:
- Production 1: For testing and exploration.
- Production 2: For runtime integration in clinical systems (requires approval).
The Authoring Server is reserved for developing and validating national code systems and can be accessed upon request.
3. Leverage the Syndication Feed
The syndication feed allows organisations to receive updates and share terminologies between systems. This is particularly useful for innovators managing their own Ontoserver or other FHIR-compatible terminology servers. By subscribing to the feed, developers can automate content updates, ensuring systems always reflect the latest terminology standards.
4. Utilise APIs for Advanced Use Cases
The Terminology Server APIs provide extensive functionality for querying and managing terminologies. Examples include:
- Performant Searches: Use APIs to implement intelligent search features within clinical applications. For instance, a system could support autocomplete functionality by dynamically querying SNOMED CT.
- Concept Mapping: Innovators can map local terminologies to national standards, ensuring that their applications are compatible with NHS datasets.
- Validation: Developers can validate terminology bindings against specifications, ensuring compliance with NHS and FHIR standards.
5. Integrate Analytics and Decision Support
For analytics platforms, the Terminology Server offers tools to translate and validate content on demand. By leveraging these capabilities, innovators can incorporate standardized terminologies into advanced queries, predictive models, and reporting dashboards. Decision support systems, meanwhile, can use the server to enhance subsumption logic and offer more precise clinical recommendations.
6. Build Local Capabilities
While the NHS Terminology Server provides robust support, organisations may wish to manage their own terminologies or extend server capabilities. The NHS has established a procurement framework with Dedalus and CSIRO, enabling organisations to purchase their own Ontoserver and connect it to the NHS infrastructure. This approach allows greater control over local content authoring and mapping.
Challenges and Best Practices
While integration offers significant benefits, innovators should be mindful of potential challenges, including:
- Understanding Complex Terminologies: Familiarity with terminologies like SNOMED CT is essential. Training resources provided by NHS England, including self-service tutorials and GitHub examples, can help bridge knowledge gaps.
- Ensuring Security and Compliance: When handling sensitive healthcare data, adherence to security best practices and compliance with NHS regulations is paramount. Use authentication mechanisms and adhere to API guidelines to maintain data integrity and privacy.
- Testing in Controlled Environments: Use Production 1 for testing before deploying to runtime environments. This ensures smooth integration and minimizes the risk of disruptions in live clinical systems.
Conclusion
The NHS Terminology Server is a cornerstone of digital transformation in UK healthcare, providing a unified platform for managing, sharing, and analysing standardised terminologies. By integrating with this server, digital health innovators can build solutions that are interoperable, scalable, and aligned with NHS priorities. Whether developing clinical applications, analytics platforms, or decision support tools, innovators can leverage the server’s rich APIs, syndication capabilities, and FHIR compliance to streamline development and improve healthcare outcomes. With resources like detailed documentation, training guides, and a supportive framework for procurement and integration, the Terminology Server represents a significant opportunity to accelerate innovation in the health and care sector.