General Principles & Design

The Longitudinal Record Access (LRA) project is designed to provide secure, standardized access to clinical data across British Columbia by integrating information from multiple sources. Leveraging national and provincial standards, LRA aims to ensure seamless interoperability and real-time access for both healthcare providers and patients. Built on Fast Healthcare Interoperability Resources (FHIR) standards, LRA ensures scalability, reliability, and alignment with national specifications like CA Core, PS-CA, and CA:FeX.

The project is a foundational component of BC’s healthcare infrastructure, facilitating data exchange across electronic medical records (EMRs), clinical information systems, and patient/provider portals. This document outlines key design considerations that guide the LRA’s development, including alignment with national standards, terminology services, and core architectural principles.

Alignment with National Standards:

LRA is fundamentally designed to build upon and align with national specifications like CA Core and CA Baseline. This allows BC to leverage established national profiles (Patient Summary, eReferral) while accommodating provincial requirements.

As shown in the diagram below, BC Core Standards, such as the BC Patient Summary and LRA standards, are derived from CA Core Standards (which include Patient Summary, CA:FeX, and eReferral). These core standards are informed by both national (CA) and provincial (BC) standards (such as Client Registry, PLR, etc.) to ensure that BC-specific needs are addressed while maintaining consistency with broader national requirements.

The diagram illustrates the flow of data between national and provincial standards, terminology servers, and core systems like the Longitudinal Record Access (LRA) platform. BC standards derive from the CA Core, leveraging national terminology services (e.g., SNOMED CT and pCLOCD) through syndication feeds while also maintaining provincial services such as BC Terminology Servers.

Where gaps exist (for example, in national specs like CA:FeX when compared to international standards like IPA), the LRA project will work with national standard bodies such as Infoway to discuss those discrepancies. This ensures BC's needs are continuously represented at the national level.

Terminology Services:

LRA will have its own terminology services, but these will rely heavily on national terminologies (like SNOMED CT and pCLOCD) to maintain semantic consistency. The syndication feeds from the national terminology server ensure that LRA remains in sync with national and provincial terminology standards.

LRA will use these terminologies to support coding systems and value sets specific to BC, ensuring that clinical data is both understandable and interoperable across the province.

General Considerations for LRA Design:

• Scalability and Performance: As the diagram shows, data from various sources (national standards, provincial standards, and local systems) flow into LRA. This necessitates a scalable architecture that can efficiently handle large volumes of data and ensure real-time access to clinical information.
• Interoperability: LRA is designed to be highly interoperable, using FHIR APIs and SMART on FHIR applications to facilitate seamless data exchange across multiple systems (EMRs, patient portals, clinical information systems).
• Governance and Feedback: As a back-end service, LRA will continuously evolve through feedback from national and provincial standard bodies and alignment with standards like CA Core and BC Core. The architecture allows for updates and revisions as specifications evolve.