Expansion stage 0 (Q2 2024)

First the Code systems and an value list oft of the BfArM (Code Systems & Registries section) were converted into a FHIR format until middle oft he year 2024. The individual systems were published in the form of FHIR packages via a pre-release of the central terminology server and made available for comment. This affected the following code systems and the value lists derived from them:

• ICD-10-GM 2024 / 2023 / 2022
• ICD-O-3 Zweite Revision 2019
• ICF 2004
• LOINC - Linguistic Variants Deutschland 2.77
• OPS 2024 / 2023 / 2022
• ORPHAcodes 2024

The comments received were discussed with the relevant stakeholders. A concept for the allocation, use and registration of canonical URLs that uniquely identify terminology was developed in consultation with the Competence Center for Interoperability in Health Care (KIG).

Expansion stage 1 (Q4 2024)

The first stage of the central terminology server, which went live at the end of 2024, provides code systems, value lists and mappings in HL7 FHIR format via a graphical user interface and standardized interfaces. The focus of the first stage of development is to support IT systems in the healthcare sector that regularly require the latest versions of the BfArM's code systems and value lists. Via the NPM API of the central terminology server, these IT systems can now retrieve the provided content via an interface, enabling fully automated processes for maintaining internal coding databases.

The central terminology server is based on an open-source platform developed by ELGA GmbH and already in use in Austria. (https://gitlab.com/elga-gmbh/termgit or https://elga-gmbh.gitlab.io/termgit). ELGA GmbH, gematik, BfArM and eHealth Suisse are jointly developing this platform, thus creating a basis for a wide range of synergies in connection with German-language code systems and value lists.

The interactive user interface of the central terminology server provides information on every coding system, every list of values and every mapping.

• an “Overview” with basic information on content and source,
• a “Download” area for retrieving the main table in JSON and XML coding and as an FHIR package encapsulating all content.
• The “Preview” area contains an overview of the structure (properties) of the coding system/value list/mapping as well as a tabular overview of how the coding system/value list/mapping is structured.
• The most recent version of the coding system/value list/mapping can be accessed via “Previous versions”, which provides access to all previous versions converted to the FHIR format.

Before the first download, you must confirm the download conditions. If the browser cache is not emptied, this is done once for each piece of content provided and applies to all versions. The “Download Conditions” section contains an overview of all download conditions for the content provided on the central terminology server in PDF format. These can be used for documentation and also for distribution to third parties.

In addition to the user interface, content can be accessed via an interface (API). Instructions on how to use this interface, which follows the HL7 FHIR guidelines, can be found in the section “Information on FHIR Packages”. To use the interface, you must first confirm the download conditions. This generates digital proof (known as an access token), which can then be added when accessing the interface.

Expansion stage 2 (in preparation)

The focus of the next stage of development is to support the electronic health record for everyone by providing the code systems, classifications and value lists required for the digitally supported medication process.

In terms of functionality, the second stage of development focuses on improving the usability of the graphical user interfaces. In particular, this includes more powerful functions for searching for concepts and more convenient navigation in the previews.

Further expansion stages (planned)

After the conditions for a rapid expansion of further semantic content on the central terminology server have been created in the second stage of development, new fields of application and connectable systems should also be added from the third stage of development. For example,

• ePA client systems should be able to resolve individual concepts on the central terminology server via FHIR interfaces or to display structured forms in several languages using multilingual concept identifiers
• decentralized terminology servers – e.g. of the university hospitals – can be synchronized with the central terminology server via suitable interfaces
• decentralized authoring systems for creating and maintaining terminology can be further integrated with the central terminology server to support rapid cycles of publishing current versions.