Local Swiss requirements: Swiss-specific systems, such as Swiss Diagnosis Related Groups (SwissDRG), need to be taken into account, i.e., the terminology service needs to cover the terminologies required for accounting, e.g., CHOP, which is Swiss-specific and only valid for coding procedures for inpatients. CHOP itself does not provide official Internationalized Resource Identifiers (IRI) for each CHOP code; therefore, IRIs need to be created in an SPHN/BioMedIT namespace. In addition, CHOP can be properly used in the SPHN RDF schema only if IRIs are available, including IRIs for different versions. Hosting our own terminology service allows us to keep control of the compatibility of the terminology versions and the SPHN data schema versions represented in RDF [19]. Timing the release and use of versions of terminology: When a new version of a terminology is released, it does not necessarily mean that it is immediately used in hospitals. For example, the German Modification of ICD-10 is valid in Switzerland for coding the diagnoses of inpatients. However, due to the time needed for translation into French and Italian, a new version of ICD-10-GM is only adopted every two years, whereas the German Federal Institute of Drugs and Medical Devices (BfArM) in Germany releases a German Modification of ICD-10 every year. Licensing: Each piece of terminology comes with its own license conditions, which must be respected when setting up a terminology service. There are a number of terminologies that are freely available, such as LOINC. Additionally, there are licensing models based on the membership of an organization, e.g., Switzerland is a member of SNOMED International and, thus, users can exploit SNOMED CT free of charge if they use the terminology in Switzerland, by registering with the national release center (NRC). However, other organizations that develop terminologies are more restrictive when it comes to the usage with multiple partners. Therefore, sharing terminology is only allowed under certain conditions, and hurdles have to be overcome to make the semantic standard available to a community in an integrated environment. Special attention is required for the use of these terminologies in multi-institutional settings, such as the SPHN projects. An assessment of these requirements has led to the federated design of a terminology service for the SPHN (see option two in Figure 1). Hospitals and service providers have the ability to host their own local SPHN terminology services supporting exactly the terminologies, versions, modifications or editions that are used in the SPHN, rather than connecting to a general existing service such as BioPortal. Keeping a terminology service up to date is a resource-intensive process, as the individual steps, such as converting new versions into a specific format and validating and uploading them, are very time-consuming. The use of a continuous integration/continuous deployment (CI/CD) pipeline is commonly used in software development to automate the delivery process of a tool, with code builds and test runs [20]. We, therefore, developed such a pipeline to automate the conversion of the provided terminologies into an SPHN-compatible RDF format, their validation and upload to the terminology server.