Project Background
Virtual Care Project Background
The acceleration in the use of virtual care and digital health tools has created a new urgency to address several common barriers to effective digital health, including:
- Siloed information and a lack of interoperability, including lack of semantic interoperability as many EMR systems do not encode clinical data elements, which will be a major gap when transitioning towards international vocabulary standards
- Constrained values (value sets) that are challenging for clinicians, voiced by jurisdictions and vendors
- Aging and disconnected digital health systems and infrastructures that cannot easily communicate with one another
- Messaging solutions that are not integrated into provider systems or workflows and are not user-friendly
Virtualization of care has heightened the need for safe and efficient electronic communication, collaboration and sharing of information across the circle of care. The COVID-19 pandemic has accentuated the importance of interoperability.
In support of provinces and territories, Canada Health Infoway is facilitating a national collaborative effort to advance interoperability in two priority areas identified through extensive consultations:
- Secure sharing of patient summaries across different solutions to support transitions of care and cross-jurisdictional patient flows
- Secure messaging between solutions to enable safer and more efficient collaboration across the circle of care (e.g., provider to provider secure electronic communication)
Need for Modern Exchange Standards
Exchange patterns outlined in IHE profiles, like Mobile access to Health Documents (MHD) and Cross-Enterprise Document Sharing (XDS), were initially explored as part of the pan-Canadian Patient Summary (PS-CA) Interoperability Specification. However, early implementers were quick to identify the need to put forward and harmonize around modern RESTful API patterns for exchanging documents and other forms of patient data.
As part of this discovery, a market scan was performed to evaluate patterns used in existing RESTful-driven FHIR Implementations guides (e.g., US Core, IPA, PACIO, IPS, etc.). Learnings from this scan, and feedback from the Canadian implementer community ultimately led to the development of the initial instalment of the Canadian FHIR Exchange (CA:FeX) Specification.
Pan-Canadian FHIR Exchange (CA:FeX) Interoperability Specifications
CA:FeX v1.0.0 Trial Implementation
Given the focus of early implementers to exchange patient summaries as a FHIR Document, CA:FeX 1.0.0 Trial Implementation was scoped to outline simple exchange patterns that allow for the search, retrieval, and submission of FHIR Documents. There are multiple ways in which documents can be formatted and interacted with in the RESTful paradigm. To read more about the various ways in which documents may be formatted, see Document Exchange and the CA:FeX Whitepaper.
Details regarding CA:FeX v1.0.0 Trial Implementation and its earlier releases can be found here.
Current Release
This release expands on CA:FeX v1.0.0 Trial Implementation and provides additional guidance on the initial set of Search Parameters and resource exchange capabilities that FHIR Servers in Canada are expected to support. This release also explores an initial set of Operations that are expected to provide value to early implementers.
Implementers are encouraged to read Scope and Relationship to Other Specifications as a preface to the technical guidance in this implementation guide.