NHS England Terminology Server - System-to-System Account Agreement

1.1 Please read this System-To-System Account Agreement carefully before you start to use a System-To-System Account on the NHS England Terminology Server.

1.2 A System-To-System Account Agreement must be in place between your organisation and NHS England, where your organisation intends to access the Terminology Server using a System-To-System Account. Only a single System-To-System Account Agreement is required between your organisation and NHS England, irrespective of the number of System-To-System Accounts your organisation uses. The System-To-System Account Agreement must be accepted by an authorised representative of your organisation prior to making use of a System-To-System Account.

1.3 This is version 2.01 of this System-To-System Account Agreement, which was published on 9 March 2023.

2.1 The following definitions are used in this System-To-System Account Agreement:

Authenticated User means a user that requires access to restricted content and/or requires update permissions within the Terminology Server. These users will require a Terminology Server account and will be required to login to the Terminology Server.

Authoring Tool means a component of the Terminology Server that enables Users (excluding System-To-System Account End Points) to create and maintain FHIR compliant CodeSystems, ValueSets and ConceptMaps.

Classification means a set of standardised groupings of information that allow for the translation of medical terminology used in healthcare settings into codes that can be easily tabulated, aggregated, and sorted for statistical analysis in an efficient and meaningful manner.

Commencement Date means the date on which NHS England provides client credentials for your requested System-To-System Account End Point.

Confidential Information means all information which is disclosed before or after the Commencement Date by one party to the other however conveyed and which: (i) is marked confidential or which is accompanied by a written or oral statement saying that it is confidential or proprietary or (ii) ought reasonably to be considered confidential; and which relates to the business affairs of the party disclosing it (including, products, operations, processes, plans or intentions, developments, trade secrets, know-how, design rights, market opportunities, personnel, customers and suppliers of the party disclosing it (or other companies within a group of companies owned by or under common ownership of that party)), and all information derived from the above;

Content Licences Agreement means an agreement which includes all licences for the individual Terminologies and Classifications held as Terminology Resources within the Terminology Server, setting out the terms and conditions under which System-To-System Account End Points may use the content within the Terminology Server.

Intellectual Property Rights means (a) patents, utility models, petty patents, rights in trade secrets and other confidential or undisclosed information (such as inventions (whether patentable or not or know-how), registered designs, database rights, design rights, rights in copyright (including moral rights),  semiconductor topography rights, mask work rights, and trademarks: (b) all registrations or applications to register any of the rights referred to in paragraph (a); and (c) all rights in the nature of any of the rights referred to in paragraph (a) including continuations, continuations in part and divisional applications, rights in unfair competition and, without prejudice to anything else in this definition, rights to sue for passing-off and rights having the  equivalent or similar effect to, and the right to apply for any of the rights listed in this definition, in any country or jurisdiction.

NHS England Terminology Server is synonymous with the term Terminology Server.

Non-authenticated User means a user that requires access to public content and does not require update permissions within the Terminology Server. These users will not require a Terminology Server account and will not be required to login to the Terminology Server.

Service Provider means the contracted organisation (CSC Computer Sciences Limited trading as DXC Technology) providing the Terminology Server.

System-To-System Account means an account within the Terminology Service, for the purposes of supporting computer systems to use authenticated API calls to the Terminology Server using client credentials.  A System-To-System Account can provide access to public and restricted content, and can grant read and/or update permissions. All computer system-initiated API calls to the Terminology Server require a unique System-To-System Account.

System-To-System Account Agreement means this agreement (together with the documents and links referred to in it) setting out the terms and conditions under which System-To-System Account End Points may use the Terminology Server.

System-To-System Account End Point means an external system that requires access to the Terminology Server using a System-To-System Account.

Terminology means a set of codes used in healthcare settings that describe a patient's complaint, problem, diagnosis, treatment, or other reason for seeking medical attention.

Terminology Resource means the FHIR resources (CodeSystems, ValueSets and ConceptMaps) within the Terminology Server.

Terminology Server means the system comprising the Terminology Service and Authoring Tool and includes Ontoserver, Atomio, Ontocloak, Snapper and OntoAdmin software components and is provided by the Service Provider. System-To-System Account End Points do not make use of the Authoring Tools.

Terminology Service means a component of the Terminology Server that enables healthcare applications to make use of codes and value sets without having to become experts in the fine details of CodeSystem, ValueSet and ConceptMap resources, and the underlying code systems and terminological principles (as defined within FHIR).

Users means System-To-System Account End Points, Authenticated Users and Non-authenticated Users.

Virus means computer viruses, trojans, worms, logic bombs, disabling code or routines, or other materials which are malicious or technologically harmful.

We, our, us are references to NHS England.

You or your means an individual or organisation responsible for a System-To-System Account End Point.

3.1. This System-To-System Account Agreement (together with the documents and links referred to in it) set out the terms and conditions under which you may use a System-To-System Account to access the Terminology Server.

3.2 This System-To-System Account Agreement shall take effect on the Commencement Date and shall continue until this System-To-System Account Agreement is terminated in accordance with its provisions.

3.3. You may access and use the Terminology Server as a System-To-System Account End Point.

3.4 When accessing and using the Terminology server through a System-To-System Account, you may do so only if you:

1. request a Terminology Server System-To-System Account, and as part of making the request, you will be required to accept this System-To-System Account Agreement and the Content Licences Agreement;
2. agree to be legally bound by this System-To-System Account Agreement and the Content Licences Agreement every time you access the Terminology Server. If at any time you do not agree to be legally bound by this System-To-System Account Agreement and the Content Licences Agreement you must not use your System-To-System Account End Point to access or use the Terminology Server.

3.5 We will notify you from time to time of any technical requirements or standards which your system must comply with in order to use the Terminology Service.

3.6 When you access the Terminology Server via a System-To-System Account, you shall comply with the terms described in this System-To-System Account Agreement and, where applicable, the Content Licences Agreement (such use of the Terminology Server includes accessing, viewing, interacting with, logging in to, downloading materials or data from, uploading content, or using the Terminology Server in any other way).

3.7 The Terminology Server will operate as a managed service, 24/7 (365 days a year). Where updates and patches are implemented (as and when required), this should not impact upon the availability of the Terminology Server.

3.8 To protect the availability of the Terminology Services as a shared resource for the health and social care service in England, NHS England reserves the right to:

1. modify the Terminology Server;
2. refuse access to the Terminology Server;
3. restrict or modify access to the Terminology Server;
4. suspend access to the Terminology Server; or
5. terminate the Terminology Server.

3.9 You shall not (and shall ensure that any third parties acting on your behalf shall not) use the Terminology Server in a manner that (in NHS England's reasonable opinion) constitutes excessive use beyond fair usage volumes and/or a breach of terms within this System-To-System Account Agreement.

3.10 Making use of the Terminology Server is done so entirely at your own risk and NHS England assumes no duty of care or other legal liability or responsibility to any person who makes use of the Terminology Server for any loss or damage suffered by them as a result of such use nor shall NHS England be liable to contribute to or otherwise share in any liability to compensate any third party harmed as a result of the usage of the Terminology Server.

3.11 The Terminology Server is provided on an “as is” basis without (to the extent permitted by law) any warranty or representation of any kind either express or implied (including the implied warranties of merchantability and fitness for a particular purpose).

3.12 To the extent permissible by law, NHS England shall not be liable for any direct, special, indirect or consequential losses and/or damages nor for any loss (whether direct or indirect) of use, data, business or profits arising out of or in connection with this System-To-System Account Agreement, whether such liability arises from any claim based upon contract, warranty, tort (including negligence), strict liability or otherwise, and whether or not NHS England has been advised of the possibility of such loss or damage.

4.1. We may make changes at our discretion to the content and features of the Terminology Server, this System-To-System Account Agreement, the privacy policy, and any other policies or links applicable to your use of the Terminology Server, at any time and for any reason. We will use all reasonable endeavours to notify you in advance of the implementation of any such changes, but reserve the right to make urgent or necessary changes without providing advance notice of those changes to you.

4.2. Every time you wish to use the Terminology Server, you should ensure that you remain cognisant to and in agreement with, any changes to the provisions within the System-To-System Account Agreement and Content Licences Agreement. NHS England may request, from time to time, a formal re-acceptance of this System-To-System Account Agreement. NHS England will seek to support continuity of service, by allowing continued access through the System-To-System Account, while awaiting any formal re-acceptance.

4.3. NHS England does, however, reserve the right to deny access to the Terminology Server where a formal re-acceptance of the System-To-System Account Agreement has been requested but not has been received, i.e. you may not be able to use the Terminology Server (or any of its functions, or access data) until you have accepted any new or additional terms.

5.1 When you access the Terminology Server, we process information about the System-To-System Account End Point. A Privacy Policy applicable to the Terminology Server is available at https://digital.nhs.uk/services/terminology-servers/privacy-policy. By using the Terminology Server you warrant that all data provided by you for verification of identity, access, and security purposes is accurate.

5.2 No personal information is processed by the Terminology Server in operating a System-To-System Account or System-To-System Account End Point.

6.1 This System-to-System Account Agreement is not confidential and does not contain any Confidential Information. Each party may however give Confidential Information to the other party and in such cases, subject to other provisions in this System-to-System Account Agreement, all Confidential Information given by one party to the other, or otherwise obtained or developed by one party relating to the other, shall be kept secret and confidential by the receiving party for the duration of this System-to-System Account Agreement plus 3 years following its termination or expiry and shall not be used or disclosed without the prior written consent of the other party other than for the purposes of the proper performance of this System-to-System Account Agreement.

6.2 The obligations of confidentiality in this paragraph 6 shall not extend to any matter which the receiving party can show:

1. is in, or has become part of, the public domain other than as a result of a breach of the obligations of confidentiality under this System-to-System Account Agreement;
2. was independently disclosed to it by a third party entitled to disclose the same; or
3. is required to be disclosed under any applicable law, or by order of a court or governmental body or authority of competent jurisdiction.

6.3  For the avoidance of doubt, NHS England may disclose your confidential information:

1. to the Department of Health and Social Care, NHS England, and to any other health or social care body;
2. to any central government body;
3. to the UK Parliament, Scottish Parliament or Welsh or Northern Ireland Assemblies, including their committees;
4. if NHS England (acting reasonably) deems disclosure necessary or appropriate while carrying out its public functions;
5. on a confidential basis to exercise its rights or comply with its obligations under this System-to-System Account Agreement; and/or
6. on a confidential basis to a proposed transferee, assignee or novate of, or successor in title to, NHS England.

6.4 References to disclosure ‘on a confidential basis’ will mean disclosure subject to a confidentiality agreement or arrangement containing the same obligations as those placed on NHS England.

6.5 The reference in this paragraph 6 to central government bodies shall include the following sub categories of the Central Government classification of the Public Sector Classification Guide, as published and amended from time to time by the Office for National Statistics:

1. Government Department;
2. Non-Departmental Public Body or Assembly Sponsored Public Body (advisory, executive, or tribunal);
3. Non-Ministerial Department; and
4. Executive Agency.

6.6  In relation to NHS England's obligations under the Freedom of Information Act 2000 and/or central government transparency requirements, you hereby give your consent for NHS England to publish to the general public the confidential information. NHS England shall, prior to publication, take reasonable steps to consult with you on the manner and format of publication and to inform you of its decision regarding any redactions but NHS England shall have the final decision in its absolute discretion and you acknowledge that NHS England may be required to disclose confidential information without consulting you.

7.1 The status of your system as a System-To-System Account End Point of the Terminology Server requires that you have accepted the terms laid out in paragraph 3 above. We reserve the right to remove your system status as a System-To-System Account End Point of the Terminology Server at our discretion.

7.2. We make no assumption that your System-To-System Account End Point will access the Terminology Server from within England, and we are not responsible or liable for your compliance with any local laws, appropriate to the geographic area from which you seek to access the Terminology Server. We may limit the availability of the Terminology Server to any System-To-System Account End Point or geographic area at any time at our discretion.

7.3. You recognise that the Terminology Server is a service available to other Users, and that access or capacity may on occasion be limited. You will comply with any guidance as to fair use that may be given by us from time to time. You recognise that we may need to suspend or limit usage that is in excess of fair usage at our discretion or where we consider it may impact other Users.

7.4. In using the Terminology Server, you are giving us or the Service Provider permission to monitor your use of the Terminology Server and take actions that may be necessary in relation to any breach by you of the terms of this System-To-System Account Agreement.

7.5. We do not guarantee or warrant that the Terminology Server will be secure or free from viruses, that the functions of the Terminology Server will be uninterrupted or error free, that defects will be corrected, or represent the full functionality, accuracy, or reliability of the materials or data.

8.1 In order to use the Terminology Server and/or access certain content or features of the Terminology Server as a System-To-System Account End Point, you are required to complete a System-To-System Request Form and submit to NHS England for consideration.

8.1.1 You will provide contact details for individual(s) who will be the day-by-day contact for matters relating to this System-To-System Account and the System-To-System Account End Point.

8.1.2 You will provide all necessary information to enable NHS England to configure and operate the System-To-System Account within the Terminology Server, as per the request form available from NHS England.

8.1.3 If this is your organisation’s first request for a System-To-System Account End Point, you will provide a written confirmation, by an authorised representative of your organisation, of the acceptance of the terms and conditions within the System-To-System Account Agreement. Subsequent registrations of a System-To-System Account End Point will be covered under the System-To-System Account Agreement already in place.     

The System-To-System Account Request form requires that you:

1. Confirm you are authorised to enter an agreement between your organisation and NHS England; and
2. Accept the terms and conditions laid out in the System-To-System Account Agreement.

8.1.4 NHS England will provide client credentials, which must be set up within your System-To-System Account End Point, that will be used for authentication purposes when your System-To-System Account End Point attempts to access the Terminology Server. The Commencement Date for the System-To-System Account Agreement, between your organisation and NHS England, will be date that NHS England provide the client credentials.

8.2 You agree to provide accurate and current information when requesting a System-To-System Account to access the Terminology Server and you agree to notify NHS England of any changes in the supplied information to enable NHS England to keep it up to date and accurate at all times.

8.3 You must treat your client credentials as confidential and only disclose them if required for the purposes of configuring your System-To-System Account End Point.

8.4 If you know or suspect that your client credentials have been compromised or that your access to the Terminology Server has been compromised, you must promptly:

1. contact [email protected] and request new client credentials;
2. notify the NHS England National Service Desk by writing to [email protected] or by calling +44 300 303 5035.

8.5 If you require the generation of new client credentials for your System-To-System Account End Point (other than in those circumstances described in paragraph 8.4, you should contact [email protected] and request new client credentials.

8.6 If or when you no longer require access to the Terminology Server as a System-To-System Account End Point, you should contact [email protected] and request that your System-To-System Account be deleted. Upon deletion of your System-To-System Account this System-To-System Account Agreement shall be deemed as terminated.

9.1. You may only use the Terminology Server for lawful purposes and in accordance with this System-To-System Account Agreement, and agree not to access without authority, interfere with, damage or disrupt:

1. any part of the Terminology Server or any of the data found therein;
2. any equipment or network on which the Terminology Server is stored;
3. any software or services used in the provision of the Terminology Server; and/or
4. any equipment or network or software owned or used by any third-party.

9.2. You may not use the Terminology Server:

1. in any way that breaches this System-To-System Account Agreement or any applicable local, national, or international law or regulation;
2. unlawfully, fraudulently, maliciously, or in any way that is harmful to us, any third party or other Users, that has any unlawful, fraudulent, malicious, or harmful purpose or effect;
3. to send, knowingly receive, upload, download, use or re-use any material which you do not have the right to do so or which does not comply with this System-To-System Account Agreement;
4. to knowingly send or transmit any data that contains Viruses;
5. with the login details of another User, or permit any unauthorised person to use your login details to use the Terminology Server;
6. in any way which would change the Terminology Server or infringe on any Intellectual Property Rights in relation to using the Terminology Server;
7. in any way which attempts to unencrypt or otherwise intercept any transmission of data to or from the Terminology Server or any applicable third parties;
8. in any way which could disable or compromise the security of the Terminology Server;
9. to stage, ingest or manually input person, personal or patient related data into the Terminology Server (other than relating to the management of User accounts for accessing the Terminology Server); or
10. in any way, to export a Terminology Resource where it will breach the terms of the licence for that Terminology Resource (as stated in the Content Licences Agreement).

10.1. The Intellectual Property Rights pertaining to your use of the Terminology Server content are set out in the applicable licence agreements for Terminology Resources (which are contained within the Content Licences Agreement).

10.2. NHS England or its licensors own all Intellectual Property Rights in the Terminology Server and the NHS England content. Your licence to use the Terminology Server and the NHS England content is as set out in this System-To-System Account Agreement and applies whilst you utilise a System-To-System Account to access the Terminology Server.

11.1. You may only upload content to the Terminology Server where we have provided you with suitable permissions and where any licence relating to that content allows you to do so.

11.2 Whenever you make use of a feature that allows you to upload content to the Terminology Server, or to make contact with other Users of the Terminology Server, you must comply with the content standards set out in this System-To-System Account Agreement and the Content Licences Agreement. You warrant that any such contribution does comply with those standards, and you will be liable to us and indemnify us for any breach of that warranty. This means you will be responsible for any loss or damage we suffer as a result of your breach of warranty.

11.3 Any content you upload to the Terminology Server will be considered non-confidential and non-proprietary. Subject to the terms of the Content Licences Agreement you will retain all of your ownership rights in your content, but you are required to grant us and other Users of the Terminology Server a limited, irrevocable, non-exclusive, royalty free licence to use, store and copy that content and to distribute and make it available to third parties.

12.1. We will not be liable to you for any loss or damage, whether in contract, tort (including negligence), breach of statutory duty, or otherwise, even if foreseeable, arising under or in connection with: (i) use of, or inability to use, the Terminology Server; or (ii) any loss in connection with any error, omission, defect, virus, or system failure.

12.2. We will not be liable for any loss or damage caused by a Virus which may infect your device, computer equipment, computer programs, data or other proprietary material due to your use of the Terminology Server or in relation to your downloading of any content or data from the Terminology Server, or on or from any third party website linked to the Terminology Server.

12.3. We do not assume any responsibility for the content of third-party websites which may be linked on the Terminology Server. Such links should not be interpreted as an endorsement of those linked websites. We will not be liable for any loss or damage that may arise from your use of them.

12.4. To the extent permitted by law, we exclude all other conditions, warranties, representations or other terms which may apply to the Terminology Server or any data or content on it, whether express or implied.

12.5. You agree to reimburse us for any losses that we incur as a result of your:

1. breach of, or failure to comply with, this System-To-System Account Agreement; or
2. unauthorised use of the Terminology Server.

13.1. We do not guarantee that the Terminology Server will always be available or that your use of the Terminology Server will be uninterrupted, but the Terminology Server will operate in accordance with the SLAs for the technical solution (and which are available from NHS England).

13.2. We may suspend, withdraw, discontinue or change all or any parts of the Terminology Server without notice and without compensation to you.

13.3 We shall have the right to suspend and/or terminate this System-To-System Account Agreement and/or your permission to access the Terminology Service with immediate effect by written notice if you:

1. are, or are adjudicated or found to be, insolvent as set out in section 123 of the Insolvency Act 1986 (whether or not the company is registered or unregistered) or stop or suspend payments of your debts or are (or are deemed to be) unable to or have no real prospect of being able to or admit inability to pay your debts as they fall due or fail to satisfy any judgment debt in whole or in part within 14 days of the judgment date; or
2. enter into an arrangement, compromise or composition in satisfaction of your debts with your creditors or any class of them; or
3. pass a resolution or make a determination to be wound up (without a declaration of solvency / except for the purposes of amalgamation or reconstruction); or
4. have a winding-up order or bankruptcy order made against you; or
5. have appointed to you an administrator or administrative receiver; or
6. being a partnership, in addition to the above, suffer bankruptcy orders being made against all your partners; or
7. suffer any event or step analogous to the events or steps set out in sub-paragraphs (i) to (vi) (inclusive) in any jurisdiction.

13.4. We may, at any time, suspend or terminate your System-To-System Account and/or use of the Terminology Server (in whole or in part) temporarily or permanently. We may do this:

1. if we, or the Service Provider, are making repairs, updates, or conducting maintenance on Terminology Server tools and systems;
2. if we or the Service Provider have concerns about the security of the Terminology Server;
3. if we suspect that your System-To-System Account details have been compromised or used fraudulently or in an unauthorised way;
4. if we suspect that you may be using the Terminology Server or any data in a fraudulent or unauthorised way or in violation of this System-To-System Account Agreement;
5. if there are legal obligations which we or the Service Provider have to meet;
6. if we or the Service Provider are prevented from providing the Terminology Server for any reason beyond our reasonable control;
7. if you have not accessed or used the Terminology Server for a period of 12 months or more; or
8. for any other reason at our absolute discretion.

13.5. We will endeavour to give you advance notice of any suspension or termination, but may not be able to do so in all circumstances. We will not provide notice to you if providing that notice would compromise our security measures or is unlawful.

13.6. You may request the reactivation of your System-To-System Account if we suspend or terminate your access, but we are under no obligation to do so.

13.7. We will not be liable to you if for any reason any part of the Terminology Server is unavailable or inaccessible to you at any time or for any period.

13.8 On termination of this System-To-System Account Agreement or your right to use the Terminology Server, you must stop using the Terminology Server.

14.1. You shall configure and maintain the security of your own accessing device or system in order to access the Terminology Server safely.

14.2. You must not misuse the Terminology Server by knowingly introducing Viruses. You must not attempt to gain unauthorised access to the Terminology Server, the server on which the Terminology Server or related data is stored, or any server, computer or database connected to the Terminology Server. You must not attack the Terminology Server via a denial-of-service attack or a distributed denial-of service attack.

15.1. By requesting to access the Terminology Server as a System-To-System Account End Point and receiving client credentials, you are giving us permission to contact you from time to time by using any of the contact details which you have provided during the registration process.

15.2. You are responsible for keeping us updated if your contact details change. We are not responsible if we are not able to contact you, or if your contact details are out of date.

16.1. If any part of this System-To-System Account Agreement becomes or is held by a court to be invalid, illegal, or unenforceable, this will not affect the validity of the remaining provision which will remain in full force and effect.

16.2. Ceasing to use the Terminology Server does not affect any provision of this System-To-System Account Agreement, which are expressly or by implication intended to continue on in effect.

16.3. We may transfer our rights and obligations under this System-To-System Account Agreement to another organisation at any time and at our discretion. You may not transfer your rights or obligations to anyone else without our consent and any such purported assignment shall be deemed invalid.

16.4. No attempt by you to vary this System-To-System Account Agreement will be valid.

16.5. This System-To-System Account Agreement, its subject matter and formation (and any non-contractual disputes or claims), and the use of the Terminology Server, are governed by English law. We both agree to the exclusive jurisdiction of the courts of England in respect of any disputes or causes of action arising under these terms and conditions or the use of the Terminology Server.

If you have any queries about the use of the Terminology Server or this System-To-System Account Agreement, please contact us by email or post.

Email: [email protected] - include the following in your email subject line: NHS England Terminology Server.

Post: NHS England, 7 and 8 Wellington Place, Leeds, West Yorkshire, LS1 4AP, United Kingdom - include the following reference in your letter: NHS England Terminology Server.